Expulsive iridodialysis: An isolated injury after phacoemulsification

Abstract

I report a case of blunt trauma to an eye that had had uneventful phacoemulsification through a 5.0 mm self-sealing corneoscleral incision 4 months earlier. Total iris expulsion occurred through the cataract incision without extension of the wound or disruption of the posterior capsule or intraocular lens. A possible mechanism for this injury is discussed and related to the unique properties of the corneoscleral incision.

The long-term results of nonexpulsive total iridodialysis: An isolated injury after phacoemulsification

“…Navon, 3 Ball 4 and Rossa 5 have all reported cases of blunt trauma and expulsive iridodialysis following phacoemulsification surgery. This case shares similar characteristics, the disinsertion was at the iris root, and the capsular bag was completely unharmed.…”

“…1 The nephritis is usually self-limited but the uveitis tends to become recurrent. 2,3 In these cases where there is no response to topical treatment, systemic steroids or even second-line immunosuppression may have a beneficial effect in controlling the anterior uveitis and improving renal function.…”

Traumatic expulsive iridodialysis with vitreous prolapse

“…Traumatic expulsive iridodialysis is a rare complication after blunt trauma in eyes with previous smallincision sutureless cataract surgery [1][2][3][4]. The proposed mechanism of this complication is that the traumatic force distorts the surgical wound and causes it to leak.…”

“…The flow of aqueous humor draws the iris to plug the wound, but this creates a pressure gradient that causes disinsertion of the iris and moves it through the incision. The eye is then depressurized and the anterior chamber is reformed, avoiding global ruptures or enlargement of the surgical wound beyond its original limits [1].…”

“…In all previous reports on traumatic expulsive iridodialysis, the damage to the ocular structures was confined to the anterior segment [1][2][3][4]. The presence of an intact lens capsule with an in-the-bag IOL may limit the extension of the damage beyond the posterior capsule [3].…”