TY - JOUR
T1 - Iris defect management in the context of presbyopia-correcting intraocular lenses
AU - Fram, Nicole R.
AU - Safran, Steven G.
AU - Pratte, Eli
AU - Sheybani, Arsham
AU - Agarwal, Ashvin
AU - Houser, Kourtney
AU - Garg, Sumit
AU - Schoen, Marisa
N1 - Publisher Copyright:
Copyright © 2024 Published by Wolters Kluwer on behalf of ASCRS and ESCRS.
PY - 2024/8/1
Y1 - 2024/8/1
N2 - A 65-year-old man had uneventful cataract surgery in the right eye with a toric diffractive intraocular lens (IOL) placed fully within the capsule bag. On postoperative day 1 and week 1, the IOL was well positioned and his eye was healing normally. The plan was to proceed with cataract surgery in the left eye in the near future. One month postoperatively, he presented with blurred vision, glare, and halos and was noted to have iris prolapse out of the temporal clear corneal main incision. Of interest, the patient reported some itching and eye rubbing in the early postoperative period. He was taken back to surgery by the referring doctor, and despite 2 heroic attempts to reposit and save the iris tissue, there was significant iris loss causing transillumination defects and debilitating glare and halos.Ocular examination revealed an uncorrected distance visual acuity (UDVA) of 20/40 - 2 J3 and binocular corrected distance visual acuity (CDVA) 20/30 J1 in the right eye and UDVA of 20/60 J3 and binocular CDVA of 20/25 J1 in the left eye. Manifest refraction was -0.25 -1.25 × 155 in the right eye and plano -2.25 × 090 in the left eye. Fortunately, there was no relative afferent pupillary defect, and intraocular pressures were normal off all drops.On slitlamp examination of the right eye, pertinent findings revealed a protective ptosis, trace conjunctival injection with 1 large subconjunctival polypropylene flange at 8:30 o'clock 1.5 mm from the limbus and 1 exposed irregular polypropylene flange eroded through the conjunctiva at 10 o'clock 0.5 mm from the limbus (Figures 1 and 2Figure 1.Preoperative slitlamp photograph of an attempted iridodialysis repair with flanged 6-0 polypropylene exposed at 8 and 10 o'clock on the sclera. In addition, there is iris sphincter damage and transillumination defects from 8 to 11 o'clock.Figure 2.Preoperative slitlamp photograph demonstrating the toric diffractive IOL technology and femtosecond capsulotomy tab designating the desired location of the toric IOL at 4 degrees.). There was a localized area of erythema and scleral thinning surrounding the exposed flange. The cornea was edematous over the main incision. The iris was disinserted with atrophic changes and a residual iridodialysis extending from 8:30 to 10 o'clock. The trifocal IOL was fully in the capsule bag with trace fibrosis of the capsule and rotated approximately 7 degrees off the capsulotomy tab, designating the intended axis of 1 degree. The anterior chamber was deep and quiet, and the posterior segment was unremarkable with a 0.45 cup-to-disc ratio. Pertinent examination findings in the left eye included a 2 + NS cataract and a 0.45 cup-to-disc ratio. The remainder of the examination was otherwise unremarkable.What testing and surgical plan would you offer this patient? How would you counsel regarding postoperative expectations?.
AB - A 65-year-old man had uneventful cataract surgery in the right eye with a toric diffractive intraocular lens (IOL) placed fully within the capsule bag. On postoperative day 1 and week 1, the IOL was well positioned and his eye was healing normally. The plan was to proceed with cataract surgery in the left eye in the near future. One month postoperatively, he presented with blurred vision, glare, and halos and was noted to have iris prolapse out of the temporal clear corneal main incision. Of interest, the patient reported some itching and eye rubbing in the early postoperative period. He was taken back to surgery by the referring doctor, and despite 2 heroic attempts to reposit and save the iris tissue, there was significant iris loss causing transillumination defects and debilitating glare and halos.Ocular examination revealed an uncorrected distance visual acuity (UDVA) of 20/40 - 2 J3 and binocular corrected distance visual acuity (CDVA) 20/30 J1 in the right eye and UDVA of 20/60 J3 and binocular CDVA of 20/25 J1 in the left eye. Manifest refraction was -0.25 -1.25 × 155 in the right eye and plano -2.25 × 090 in the left eye. Fortunately, there was no relative afferent pupillary defect, and intraocular pressures were normal off all drops.On slitlamp examination of the right eye, pertinent findings revealed a protective ptosis, trace conjunctival injection with 1 large subconjunctival polypropylene flange at 8:30 o'clock 1.5 mm from the limbus and 1 exposed irregular polypropylene flange eroded through the conjunctiva at 10 o'clock 0.5 mm from the limbus (Figures 1 and 2Figure 1.Preoperative slitlamp photograph of an attempted iridodialysis repair with flanged 6-0 polypropylene exposed at 8 and 10 o'clock on the sclera. In addition, there is iris sphincter damage and transillumination defects from 8 to 11 o'clock.Figure 2.Preoperative slitlamp photograph demonstrating the toric diffractive IOL technology and femtosecond capsulotomy tab designating the desired location of the toric IOL at 4 degrees.). There was a localized area of erythema and scleral thinning surrounding the exposed flange. The cornea was edematous over the main incision. The iris was disinserted with atrophic changes and a residual iridodialysis extending from 8:30 to 10 o'clock. The trifocal IOL was fully in the capsule bag with trace fibrosis of the capsule and rotated approximately 7 degrees off the capsulotomy tab, designating the intended axis of 1 degree. The anterior chamber was deep and quiet, and the posterior segment was unremarkable with a 0.45 cup-to-disc ratio. Pertinent examination findings in the left eye included a 2 + NS cataract and a 0.45 cup-to-disc ratio. The remainder of the examination was otherwise unremarkable.What testing and surgical plan would you offer this patient? How would you counsel regarding postoperative expectations?.
UR - http://www.scopus.com/inward/record.url?scp=85200278412&partnerID=8YFLogxK
U2 - 10.1097/j.jcrs.0000000000001506
DO - 10.1097/j.jcrs.0000000000001506
M3 - Article
C2 - 39083409
AN - SCOPUS:85200278412
SN - 0886-3350
VL - 50
SP - 889
EP - 894
JO - Journal of cataract and refractive surgery
JF - Journal of cataract and refractive surgery
IS - 8
ER -