Iris cerclage pupilloplasty and IOL implantation for traumatic mydriasis and aphakia after the blunt trauma of the eye

Abstract

Four patients with traumatic mydriasis and aphakia following blunt injury of the eye globe were evaluated. Patients with severe glare and photophobia due to wide pupil diameter from 6.0 to 9.0 mm were managed by combined iris cerclage pupilloplasty and retropupillar iris-claw lens implantation. The postoperative anatomic results, visual acuity, subjective degree of glare, photophobia, as well as intraoperative and postoperative complications were evaluated. The mean follow-up time was 32.6 months. Best-corrected visual acuity improved in all patients from preoperative 20/60, 20/30, 20/25, 20/22 to postoperative 20/20, 20/22, 20/20, and 20/20 (Snellen charts). All eyes achieved satisfactory anatomic result with round pupil diameter 3.5-4.5 mm. Glare and photophobia disappeared in all patients. There were no intraoperative or postoperative complications. During the follow-up period, pupils remained round and iris-claw lenses well positioned, without tilting. Combined iris cerclage pupilloplasty with retropupillar iris claw lens implantation appears to be a safe and effective surgical technique in reducing pupil size and improving visual outcomes. It is also a cost- and time-effective procedure, providing great results with a single surgery.

Keywords: Blunt eye trauma; glare; iris cerclage; photophobia; pupilloplasty; traumatic mydriasis.

Figure 1

Preoperative photographs showing wide atonic pupil in a) case 1 b) case 2 and c) case 3

Figure 2

Postoperative photographs showing reduced pupil size and round shape in a) case 1 b) case 2 and c) case 3

Figure 3

Surgical steps of cerclage pupilloplasty and iris-claw lens implantation. (a) First needle of 10-0 Prolene suture introduced at 6 o’clock is woven through the iris 0.5 mm from the pupillary margin and pulled out at 2 o’clock; (b) 23-gauge micro-forceps with serrated jaws introduced through paracenteses at 2 o’clock and used to gently grasp the iris and to further wave the second needle through the iris at the pupillary margin towards 10 o’clock; (c) Insertion of the iris-claw lens in the anterior chamber through 5.5 mm wide superior scleral tunnel; (d) Fixation of the iris claw lens: using specially designed forceps the lens is held and gently pushed behind the iris; with blunt 27-gauge canula inserted through a side limbal incision made at either 3 or 9 o’clock the iris is pushed down through the slot of the claw; (e) The pupil size and diameter are finally adjusted using a slip knot technique; (f) Viscoelastic is removed from anterior chamber with bimanual irrigation/aspiration instruments