Traumatic cataract with iridodialysis

Abstract

A 56-year-old woman presented with left blurring of vision for 6 months. She gave a history of previous left eye trauma for which she had undergone suturing of a corneal laceration. The right eye was 20/20 and normal. Her left visual acuity was hand motion. A linear corneal scar was present extending obliquely from 5 to 9 o'clock. In addition, there were iridodialysis from 8 to 1 o'clock, a fixed dilated pupil, and extensive zonulysis with displacement of a dense nuclear sclerotic cataract temporally (Figures 1 and 2JOURNAL/jcrs/04.03/02158034-202411000-00015/figure1/v/2024-10-18T161301Z/r/image-tiffJOURNAL/jcrs/04.03/02158034-202411000-00015/figure2/v/2024-10-18T161301Z/r/image-tiff). There was no vitreous in the anterior chamber. The posterior segment appeared normal, as were the intraocular pressures. Ultrasound biomicroscopy of the anterior segment of the left eye confirmed the absence of zonular fibers from 6 to 12 o'clock. Optical coherence tomography was unable to capture any image of the macular or optic nerve. Corneal topography showed irregular astigmatism. The endothelial cell density was 1650 cells/mm2. Describe how you would manage this case surgically, given that her financial resources were limited, and she was unable to afford a prosthetic iris.