Posters

Pupil reconstruction and artisan lens implantation following complicated removal of posterior capsular intraocular lens implant and secondary pupil defect

Poster Details

First Author: C.Papandreou UK

Co Author(s): A. Singh   A. Abdelrahim   H. Wassef              

Abstract Details

Purpose:

To present a challenging and uncommon case of pupil reconstruction and Artisan lens insertion in one procedure following complicated removal of posterior intraocular lens implant. Pupil trauma is one of the most common complications following complicated removal of posterior capsular intraocular lens implant, primarily presenting as sphincter tear, iridodialysis or iris defect. Aphakic eyes with iris/pupil trauma in the absence of capsular support are difficult situations to manage in terms of lens implantation and vision restoration.  Appropriate management is pivotal for those eyes to achieve the best anatomical recovery and best potential visual outcome.

Setting:

Lister Hospital, Treatment Centre, East and North Hertfordshire NHS Trust, UK

Methods:

Iris reconstruction combined with artisan intraocular lens insertion is a very challenging and highly efficient procedure. In our case, there were corneal sutures and iris trauma extending from 10 to 2 o’clock and aphakia following complicated posterior capsular opacified intraocular lens implant removal. The preoperative best corrected visual acuity was hand movements. Reconstruction of the injured iris was the first step not only to reach the goal of relieving uncomfortable symptoms such as photophobia, or glare but also to achieve a satisfactory cosmetic effect.

Results:

The operation was performed from a superior position. Two incisions were performed on the cornea on 3 and 9 o’ clock position,a main wound was made on 12 o’clock. A 10-0 prolene suture was used to repair the ruptured iris using the McCannel technique. An Artisan lens was slowly inserted in a controlled manner into the anterior chamber and was horizontally fixed at mid-periphery of the iris through the 12 o’clock corneal incision. Six weeks following the surgery, best corrected visual acuity was 6/24 unaided, pinhole 6/18. No postoperative complications were reported.

Conclusions:

In the last three decades, iris-claw and artisan IOL have been introduced to the refractive surgery, they were primarily designed for aphakic patients but were later found to be a useful tool for in the correction of phakic eyes and eyes with eye trauma. Although, Artisan IOLs are meant to be predominantly used in eyes with a healthy / normal iris because the claws require an opposite, mid-peripheral iris as support, we managed to perform pupil reconstruction and Artisan lens insertion in one procedure, a highly challenging but also very satisfying and rewarding procedure with optimal anatomical and visual outcome.

Financial Disclosure:

None