A patient suffered a knife injury to the eye that resulted in severe iridodialysis and aphakia. In this Noteworthy Case, Ashvin Agarwal, MS, walks through the steps to salvage as much remaining tissue as possible. First, an IOL is placed with intrascleral haptic fixation. The iris is then approximated with the hangback technique.
Iris reconstruction • Ocular trauma • Post Traumatic Cataract • Trauma
Hi, my name is Ashvin Agarwal, and I'm from Chennai, India. This ASCRS, I'm showing something very different. And I think it's something that we've all wondered about when treating these kinds of situations. This case is a traumatic iris repair case. This patient came to me from Iran, and had a very bad injury, a knifing injury that led to an aphakic eye with a bad traumatic iris.
To treat this case first of all, I had to treat the aphakia. So, push the iris out of the way. Make sure that you get your intrascleral haptic fixation technique right. You can always use a sutured IOL. An ACIOL is out of the question in this case, but sutured IOL, or a intrascleral haptic fixation is an apt choice for this case. After you're done with the intrascleral haptic fixation, I try to avoid a penetrating keratoplasty at the beginning.
Try and seal this problem with the iris itself. To treat the iridodialysis I'm using a hangback technique. The hangback technique is basically a suture past two spots with the loop created and the loop pulls the iris back as you see in the scenario. You suture up that iris back to its scleral wound where you created a ridge.
You really have to create this ridge again, once again on the other side. Because it's a very bad trauma, you really are trying to salvage as much of the iris as you can. And when you do this, you're able to actually resolve this to a smaller pupil size, keeping the scarred side as is. Now, I'm doing a single pass for to a pupilloplasty for the leftover iris.
This situation right now which I'm performing, has actually been very, very traumatizing to me personally because there was a very little bit of iris left, and it could have easily cheese-wired through and resulted in a very bad scenario in the end. But, all thanks to the one on top, I was able to salvage this case, and this is the postoperative 3-week picture of this patient with a vision that improved to 6/24.
Thank you so much, and that was the end of that case that I wanted to showcase in this ASCRS. Thank you so much.