Traumatic iridodialysis and mydriasis: Surgical reconstruction of the iris-lens-diaphragm with an iris implant and Intraocular lens

Abstract

Purpose: We present the case of a severe golf related ocular injury that affected the anterior and posterior segment. Treatment included primary surgical closure of the traumatic wound and secondary reconstruction of the iris-lens-diaphragm to correct aphakia and traumatic mydriasis and iridodialysis.

Observations: A 62-year-old woman presented to our clinic with severe ocular contusion after she had been hit by a golf ball in the right eye. We observed iridodialysis, traumatic mydriasis and luxation of the crystalline lens into the vitreous body as well as Berlin's edema and retinal tears. The patient underwent primary surgical closure of the traumatic wound and, 6 months later, combined Intraocular lens (IOL) and Customflex ArtificialIris (AI, HumanOptics, Erlangen, Germany) implantation. Uncorrected distance visual acuity was hand movement after primary surgical closure of the traumatic wound. After secondary reconstruction of the iris-lens-diaphragm, corrected distance visual acuity was 0.30 logMAR. Subjective impairment from glare could effectively be reduced and the patient was very satisfied with the aesthetic result.

Conclusions and importance: Combined AI and IOL implantation can successfully restore visual acuity and reduce sensitivity to glare while providing an excellent aesthetic result in patients with a history of severe blunt ocular trauma, even in cases with a poor visual acuity prognosis.

Keywords: Aniridia; Aphakia; Blunt ocular trauma; Ocular contusion; Retinal detachment.

Fig. 1

a) Binocular photography six months after primary surgical closure of the traumatic wound and before planning the pupillary and IOL reconstruction. b) Close-up of the right eye prior to secondary reconstruction of the iris-lens-diaphragm. Iridodialysis from 3 to 6 clock hours is visible c – d) Final result three months postoperatively.

Fig. 2

a) – c) Extraocular preparation of the AI and IOL. The AI was trephinated to the required size. The IOL was sewn to the backside of the AI and the haptics were shortened to reduce the size of the combined implants. d) – e) Insertion of both implants through a sclerocorneal tunnel at once.