Traumatic partial aniridia and cataract after iris-fixated foldable phakic intraocular lens implantation

Abstract

We present the first case of partial aniridia, traumatic cataract, and peripapillary subretinal hemorrhage after blunt trauma to an eye containing a foldable iris-fixated phakic intraocular lens (pIOL). Although the patient experienced visual loss because of considerable corneal astigmatism and a traumatic cataract, vision was recovered by a 2-stage primary corneal repair and cataract surgery with a toric intraocular lens. This case exhibits clinical manifestations that differ from previously reported trauma of a non-foldable iris-fixated pIOL. A relatively small corneal incision and a large optic diameter of Artiflex pIOLs may prevent posttraumatic total expulsion of intraocular tissues and present different clinical features from the case of non-foldable pIOLs (Artisan). Although the extent of the damage is different, the possibility of aniridia and traumatic cataract exists in eyes with both foldable and non-foldable iris-fixated pIOLs.

Keywords: Artiflex phakic intraocular lens; Artisan phakic intraocular lens; Phakic intraocular lens; Traumatic aniridia.

Fig. 1

Anterior segment and fundus photographs of the left eye. a At initial presentation, the dialyzed iris and the medial haptic of the pIOL were prolapsed with superior wound dehiscence (arrowhead). The Artiflex pIOL was dislocated in the anterior chamber, and another haptic was enclavated on the temporal iris (arrow). b Iridodialysis at 7 to 1 o'clock and prolapse of the iris and 1 of the haptics through the wound; the haptic-optic junction was stuck to the wound (arrowhead). c Slit-lamp photograph after primary repair. Partial aniridia at 7 to 1 o'clock with iridodialysis remained. d Fundus photography shows an inferior peripapillary subretinal hemorrhage 1 disc diameter in size (arrowheads).

Fig. 2

Photographs after the first and second operation. a Three weeks after presentation, the peripapillary subretinal hemorrhage had resolved. b Six weeks after blunt trauma, the traumatic posterior subcapsular cataract at the center of the lens had become denser, zonular dialysis (arrowhead) and an iris defect were found (arrow). c Five months after initial presentation, cataract extraction with toric IOL implantation and iridoplasty were performed. A capsular tension ring (arrow) was used for zonular dialysis. d Six months after the second operation, partial aniridia at the superior side of the left eye was partially covered by the upper eyelid.