Combined Pupilloplasty and Retropupillary Iris-Claw Intraocular Lens Implantation with DSAEK in a Patient with Traumatic Iridoplegia, Aphakia and Corneal Decompensation

Abstract

Purpose To report the management of a patient with traumatic mydriasis, aphakia and corneal decompensation with a triple procedure: simultaneous pupilloplasty and retropupillary iris-claw intraocular lens (IOL) implantation combined with Descemet stripping automated endothelial keratoplasty (DSAEK). Results An 88-year-old woman was referred to our Institute for consultation on her left eye. The patient had undergone surgical removal of the IOL, without re-implantation, in her left eye 10 months prior to presentation due to traumatic IOL dislocation. At the time of examination, corrected distance visual acuity was counting fingers and intraocular pressure was 10 mmHg. Slit-lamp examination revealed iridoplegia, aphakia and corneal edema. The patient underwent simultaneous pupilloplasty and retropupillary iris-claw IOL implantation combined with DSAEK. Six months postoperatively, the corneal graft was attached and clear, the iris was well reconstructed and almost round, and the iris-claw IOL was in place. Conclusions Simultaneous pupilloplasty and retropupillary iris-claw IOL implantation combined with DSAEK was shown to be a safe surgical technique in a patient with traumatic mydriasis, aphakia and corneal decompensation.

Long-term surgical outcomes of primary retropupillary iris claw intraocular lens implantation for the treatment of intraocular lens dislocation

“…In a recent randomized clinical trial that studied cases with IOL dislocations for six months, an average ECC loss of 10% was observed in patients who underwent IOL replacement with R-IOL, whereas a 3% ECC decompensation was observed in the IOL repositioning group 13 . However, in other studies, R-IOL implantation for correcting aphakia did not significantly decrease ECC, even in patients who had undergone penetrating keratoplasty for bullous keratopathy [27][28][29] Recently, the simultaneous performance of R-IOL implantation and Descemet endothelial keratoplasty has been proposed as a safe technique to treat aphakia with corneal decompensation 30,31 . No significant difference in ECC between IC-IOL (anteropupillary) and in-the-bag IOL has been reported 32 .…”

Implantation of retropupillary iris‐claw lenses: A review on surgical management and outcomes

“…Nevertheless, combined pupilloplasty and retropupillary iris‐claw lens implantation in eyes with traumatic mydriasis has been reported (Mikropoulos et al. 2019). In cases of extreme miosis, IOLs should probably be placed anterior to the iris in order to prevent sphincter lesions during implantation.…”

“…Although using such lenses is possible with dilated pupils-for instance, after traumatic sphincter damage-widely dilated pupils may cause patients to experience optical disturbances from the edges of the optic and the haptics, and safely enclavating the haptics may be technically demanding. Nevertheless, combined pupilloplasty and retropupillary iris-claw lens implantation in eyes with traumatic mydriasis has been reported (Mikropoulos et al 2019). In cases of extreme miosis, IOLs should probably be placed anterior to the iris in order to prevent sphincter lesions during implantation.…”

Retropupillary Iris-Claw Intraocular Lenses: A Literature Review

“…Nevertheless, retropupillary ICIOL implantation can be combined with pupilloplasty in cases with traumatic mydriasis. 58 On the other hand, in extreme miosis cases, ICIOL should be placed anterior to the iris to prevent sphincter trauma during implantation. 57 …”