Visual outcome after monocular implantation of extended depth of focus intraocular lens in a patient with iridodialysis: a case report and literature review

Abstract

Background: Iridodialysis, the separation of the iris root from the ciliary body, typically results from trauma and can lead to significant visual impairment. This case report is novel as it demonstrates the successful management of iridodialysis using an extended depth of focus intraocular lens in a patient with a slightly irregular pupil.

Case presentation: A 34-year-old Hispanic man presented with reduced vision and pain in his right eye following blunt trauma from a nail at work. Examination revealed a small temporal corneal stromal scar, traumatic posterior subcapsular cataract, two inferior iridodialysis defects, and a superiorly displaced dyscoric oval pupil. Snellen uncorrected distance visual acuity was 20/400. The patient opted for an extended depth of focus intraocular lens implantation to meet his visual demands for distance and intermediate vision without glasses. Cataract surgery with capsular tension ring, extended depth of focus intraocular lens implantation, iridodialysis repair, and suture pupilloplasty were performed uneventfully. At 1 month postoperatively, uncorrected distance visual acuity improved to 20/40, while uncorrected intermediate visual acuity and uncorrected near visual acuity were 20/20. A central, relatively round, and slightly inferiorly peaked pupil was achieved. A steroid response intraocular pressure rise at postoperative month 2 required intraocular pressure-lowering medications, and symptomatic posterior capsular opacity developed at 8 months postoperatively. At 11 months postoperatively, selective laser trabeculoplasty and laser capsulotomy were performed. At 4-year follow-up, visual acuity measurements remained stable, and intraocular pressure was normal without any medication. The patient was satisfied with the visual and cosmetic outcomes.

Conclusion: This case demonstrates that extended depth of focus intraocular lenses can be a viable option for patients with slightly irregular pupils following suture repair of the iris and pupil. The successful visual and cosmetic outcomes in this patient suggest that extended depth of focus intraocular lenses may be considered in similar complex cases, providing a balance of near, intermediate, and distance vision without significant visual disturbances.

Keywords: Cataract surgery; Extended depth of focus (EDOF) intraocular lens (IOL); Iridodialysis; Traumatic posterior subcapsular cataract.

Fig. 1

Postoperative image of the eye following cataract surgery, iridodialysis repair, and pupilloplasty, showing restored iris attachment and pupil shape