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John Hofbauer MD, Nicole Fram, MD
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John Hofbauer, MD and Nicole Fram, MD, present a case of a 41-year old male who sustained a traumatic penetrating wire injury to the right eye. The patient had emergency repair of a corneal laceration and lensectomy. Several weeks later, a secondary anterior chamber intraocular lens (AC-IOL) was implanted. One year later, an iris mass developed, shallowing the anterior chamber and pushing the AC-IOL towards the cornea. An ultrasound biomicroscopy (UBM) was performed pre-operatively and revealed a solid mass measuring 3.7 mm in size. This procedure demonstrates the removal of an AC-IOL and iris mass removal using visco-dissection, irrigation and aspiration and phacoemulsification. This "iris snowball" appeared to be retained soemmering's ring that presented as an iris mass. Interestingly, two cilia from the original ruptured globe injury were retained in the posterior chamber and removed with 23 gauge micro-forceps. A three piece PC-IOL was inserted into the sulcus without complication and the sectoral iris defect was closed with 10-0 prolene suture. Fortunately, the patient tolerated the procedure well and achieved 20/20 vision post-operatively.
Posted: 11/07/2011
John Hofbauer MD, Nicole Fram, MD
John Hofbauer, MD and Nicole Fram, MD, present a case of a 41-year old male who sustained a traumatic penetrating wire injury to the right eye. The patient had emergency repair of a corneal laceration and lensectomy. Several weeks later, a secondary anterior chamber intraocular lens (AC-IOL) was implanted. One year later, an iris mass developed, shallowing the anterior chamber and pushing the AC-IOL towards the cornea. An ultrasound biomicroscopy (UBM) was performed pre-operatively and revealed a solid mass measuring 3.7 mm in size. This procedure demonstrates the removal of an AC-IOL and iris mass removal using visco-dissection, irrigation and aspiration and phacoemulsification. This "iris snowball" appeared to be retained soemmering's ring that presented as an iris mass. Interestingly, two cilia from the original ruptured globe injury were retained in the posterior chamber and removed with 23 gauge micro-forceps. A three piece PC-IOL was inserted into the sulcus without complication and the sectoral iris defect was closed with 10-0 prolene suture. Fortunately, the patient tolerated the procedure well and achieved 20/20 vision post-operatively.
Posted: 11/07/2011
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john hofbauer
13 years ago
The patients initial surgery was done elsewhere so i don't know why an AC IOL was selected. PMMA lenses of this type rarely adhere unless they are too big and scar into the ciliary body.
ari weitzner
13 years ago
1. surprised you were able to remove ac iol so easily- i would figure that the haptics would be quite adherent to peripheral iris and resist explantation w/o tearing the iris. i once had to amputate the haptics- could not explant. 2. why was ac iol placed initially if you had adequate capsule?