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CASE REPORT
Year : 2016  |  Volume : 8  |  Issue : 2  |  Page : 69-71

Traumatic extrusion of intraocular lens with traumatic aniridia


1 Department of Ophthalmology, Calcutta National Medical College, Kolkata, West Bengal, India
2 Department of Ophthalmology, Nil Ratan Sircar Medical College, Kolkata, West Bengal, India
3 Department of Ophthalmology, IPGMER, Kolkata, West Bengal, India

Date of Web Publication17-Jan-2017

Correspondence Address:
Nabanita Barua
Department of Ophthalmology, Nil Ratan Sircar Medical College, Kolkata - 700 014, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1858-540X.198544

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  Abstract 

We report a case of posttraumatic corneal rupture with massive hyphema followed by extrusion of intraocular lens (IOL) and complete aniridia in a patient who underwent small incision cataract surgery with IOL implantation 2 years back. Repair of the corneal wound with removal of blood from anterior chamber was done. Once the media became sufficiently clear, iris ball was discovered floating in the vitreous cavity mixed with vitreous hemorrhage. Two months after the primary repair, vitrectomy with scleral fixation lens implantation was done. Best-corrected visual acuity in the right eye was 6/12 at 1-month follow-up. In pseudophakic eyes, extrusion of IOL with total aniridia after blunt trauma has rarely been reported in literature.

Keywords: Blunt trauma, extrusion of intraocular lens, pseudophakia, traumatic aniridia


How to cite this article:
Chakraborti C, Barua N, Mazumder S. Traumatic extrusion of intraocular lens with traumatic aniridia. Sudanese J Ophthalmol 2016;8:69-71

How to cite this URL:
Chakraborti C, Barua N, Mazumder S. Traumatic extrusion of intraocular lens with traumatic aniridia. Sudanese J Ophthalmol [serial online] 2016 [cited 2022 Jun 26];8:69-71. Available from: https://www.sjopthal.net/text.asp?2016/8/2/69/198544


  Introduction Top


Blunt trauma is usually associated with severe ocular damage particularly in eyes following cataract surgery. Small incision cataract surgery (SICS) is changing the pattern of presentation of such cases, with relatively favorable outcomes. [1] Traumatic aniridia is often associated with injury to the other structures of the eye. Both penetrating and blunt injuries can cause traumatic total iridectomy. [2] We present a rare case of traumatic aniridia with hyphema, subsequently intraocular lens (IOL) extrusion and vitreous hemorrhage, in which a good visual outcome was achieved after surgery.


  Case Report Top


A 60-year-old female patient presented to eye emergency of a tertiary care center with severe pain and immediate loss of vision in the right eye (RE) following a blunt trauma 3 h back. She was struck by some unknown object in her RE when she fell on ground. She had undergone SICS in the same eye 2 years back.

The patient was alert and conscious and there was no other associated injury. On ocular examination, visual acuity was only perception of light with accurate projection of rays in the RE and 6/6 in the left eye. There was marked ecchymosis, edema of the right eyelids and orbital region, subconjunctival hemorrhage, and total hyphema [Figure 1]. An X-ray of the skull and orbit showed no fractures. Slit-lamp examination after 48 h revealed dispersed hyphema mixed with vitreous in anterior chamber (AC). An intact posterior chamber IOL was recovered from the superotemporal fornix. There was no view of the iris or posterior segment structures. A self-sealed linear corneal rupture (5 mm) was found temporally at limbus. Ultrasonography did not reveal any posterior segment abnormality except scattered vitreous hemorrhage. Drainage of hyphema with anterior vitrectomy along with repair of corneal wound was repaired with three interrupted 10-0 nylon sutures under general anesthesia. Iris was completely absent, and no posterior capsule was seen. The patient was treated with topical dexamethasone and gatifloxacin combination 6 times a day for 6 weeks, atropine 1% drop three times daily for 2 weeks. With partial resolution of vitreous hemorrhage over 1 week, the iris ball was found floating in the vitreous cavity. Best-corrected visual acuity (BCVA) at 1 month was 6/24. Intraocular pressure was 16 mmHg in RE and 12 mmHg in LE. Indirect ophthalmoscopy showed attached retina. Pars plana vitrectomy was performed to clear the persistent vitreous hemorrhage at 2 months, and scleral fixation lens was implanted [Figure 2]. After 6 weeks, her BCVA in RE was 6/12. She refused to wear colored contact lens as glare was not causing much trouble.
Figure 1: Extruded intraocular lens and hyphema

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Figure 2: Aniridia with scleral fixated lens

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  Discussion Top


Blunt ocular trauma occurring after cataract extraction can result in severe visual loss with extrusion of iris, lens, vitreous, and retinal tissue through the ruptured wound. [3] In a study of ocular trauma in eyes with conventional extracapsular cataract extraction, wound rupture occurred in 86% of cases with IOL extrusion through the operative wound in 68% of cases. [4] Subconjunctival extrusion of the IOL following blunt trauma has been reported. [5] Various studies reported the presence of iris ball in the wound, in the AC or its total absence after blunt trauma. Traumatic aniridia without traumatic aphakia has also been reported. Extrusion of IOL through a full thickness glaucoma fistula after the conjunctival bleb rupture has also been previously documented. [3]

Possible explanations for traumatic aniridia are as follows:

  • Expulsion of iris through an operative wound (usually occurs in recent cataract surgery) or ruptured ocular coats
  • The iris may remain within the eye and then it may be phagocyted by macrophages and/or trabecular meshwork cells. [6]


In our patient, we postulate that blunt trauma led to an abrupt elevation of the IOP leading to sudden expansion and rupture of the globe, IOL extrusion through the wound, rupture of posterior capsule, and total iridodialysis. It was a 2-year pseudophakic eye with a SICS wound, and the IOL was extruded through a self-sealed limbal wound, not through the cataract wound. As it was a 2-year post-SICS eye, IOL was extruded through a separate wound (limbal perforation).

Many ophthalmologists have used artificial iris implants (aniridia IOL) in patients with traumatic aniridia for better cosmesis and to avoid glare. However, we could not put such lens because of its nonavailability. In the era of SICS, the effects of blunt ocular trauma are milder with a more favorable course, and the patient may get back workable vision if properly managed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Prabhu A, Nayak H, Palimar P. Traumatic expulsive aniridia after phacoemulsification. Indian J Ophthalmol 2007;55:232-3.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.
Mehta H, Mehta H, Jayadev C, Natarajan S. Combined aniridic intraocular lens implantation and vitreoretinal surgery. Indian J Ophthalmol 2007;55:391-3.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.
Lim JI, Nahl A, Johnston R, Jarus G. Traumatic total iridectomy due to iris extrusion through a self-sealing cataract incision. Arch Ophthalmol 1999;117:542-3.  Back to cited text no. 3
    
4.
Assia EI, Blotnick CA, Powers TP, Legler UF, Apple DJ. Clinicopathologic study of ocular trauma in eyes with intraocular lenses. Am J Ophthalmol 1994;117:30-6.  Back to cited text no. 4
    
5.
Mandal AK, Anand R. Traumatic pseudophacocele. Indian J Ophthalmol 2003;51:177-8.  Back to cited text no. 5
[PUBMED]  Medknow Journal  
6.
Parmeggiani F, Mantovani E, Costagliola C, Campa C, Steindler P. Total aniridia after nonperforating trauma of a pseudophakic eye: Ultrasound biomicroscopic findings. J Ultrasound Med 2007;26:1795-7.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2]



 

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