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

Abstract

Small self-sealing incisions in phacoemulsification cataract surgery confer great incision strength and stability in vivo.1,2 Isolated traumatic aniridia is extremely rare. The presented case is a non-expulsive total iris avulsion and complete iris absorption. To our knowledge this is the first case reported. The long-term sequelae of this patient and the biomechanics of self-sealing incisions are discussed.Case report

Traumatic aniridia in a pseudophakic eye

“…[4][5][6] Similar to cases in other published reports, 2,4-6 our patient suffered considerable blunt compressive force to the operated eye. She presented with reduced visual acuity, a grade 3 hyphema, and elevated IOP.…”

“…We are intrigued by the similarities of our case to those reported by Navon, 4 Ball et al, 5 and Sullivan et al 6 We agree with the proposed mechanism of injury described by Navon 4 ; ie, (a) the force of trauma transiently distorted the cataract incision, causing it to leak; (b) aqueous outflow created a lifting action over the iris that drew it to plug the wound by the Bernoulli effect 7 ; (c) this sudden block in aqueous flow caused a pressure gradient across the tunnel sufficient to disinsert the iris and deliver it through the wound; (d) renewed outflow of the iris and aqueous depressurized the eye, which prevented extension of the wound or creation of new rupture sites; (e) the impact ended; (f) the chamber reformed by the self-sealing properties of the wound or blockage of outflow by clotted blood.…”

Traumatic aniridia and self-sealed globe rupture following blunt trauma

“…Following trauma, the aqueous leaks out through the wound, the iris is pulled forward to plug the leak, as the aqueous outflow stops suddenly a pressure gradient is created, which disinserts the iris. 5 In our case, the whole iris expulsed out into the subconjunctival space, as the globe decompressed, further rupture did not develop and the scleral rupture self-sealed. This is an extremely unusual presentation and the patient did well on conservative management.…”

Isolated traumatic aniridia after trabeculectomy in a pseudophakic eye

“…[5] Such a condition usually results from a gross injury, causing severe damage to the other ocular tissues, to the extent of even rupture of the globe. A complete hyphema is the rule, usually accompanied by a massive vitreous hemorrhage as well as dislocation of the lens and detachment of the retina entailing ultimate blindness.…”

“…[2345] We report for the first time a patient who had isolated traumatic aniridia in an eye which had phacoemulsification and foldable intraocular lens as well as trabeculectomy. The mechanism and management of the glaucoma resulting from the trauma is discussed.…”