Traumatic Aniridia During Extracapsular Cataract Surgery

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Traumatic Aniridia During Extracapsular Cataract
Surgery

• Karen Chia, MD
• Lavanya Raghavan, MD
• Zainah Alsagoff, MD

There are no financial relationships to disclose.
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Introduction

• Extra-capsular cataract extraction is important
  for the resident to learn well as it is used for
• advanced cataracts or
• in patients with multiple eye conditions where
  phacoemulsification is not suitable.
• It may also be necessary to convert a case of
  phacoemulsification to ECCE at times when
  complications occur.

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• It is important thus to know complications of
  ECCE.
• Here we describe two rare cases of total aniridia
  during ECCE

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Case 1

• A 85 year old female underwent cataract surgery
  by a resident under consultant supervision.
• Pre-operative best corrected visual acuity (BCVA)
  was 6/45. Cataract was nuclear sclerosis 4.
  Pupil was small and there was difficulty in
  dilation. ECCE was performed and during nucleus
  expression there was expulsion of the iris during
  nucleus delivery.
• Infusion-aspiration was continued and eventually
  a standard IOL was inserted into the bag.

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• Her BCVA was 6/24. She had no complaints of
  glare. Intra-ocular pressure remained within
  normal with no retinal complications. Tinted
  glasses were advised.
• A phacoemulsification done for her other eye a
  couple of months later and the surgeon noted a
  floppy iris.

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Post Operative Images
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Case 2

• 59 year old male with history of benign prostatic
  hypertrophy, on terazosin, underwent ECCE.
• Pre-operative BCVA was 6/12. Cataract was nuclear
  sclerosis 3. Similarly there was iris expulsion
  with the nucleus delivery.

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• BCVA was 6/6. He was a driver and had photophobia
  and was bothered by the glare. Initially he tried
  colored contact lens but he was unable to
  tolerate it. Six months later, he underwent
  Morcher ring implantation. He developed glaucoma,
  which required treatment with 2 eyedrops.

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Post Operative Images
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Discussion

• It is extremely uncommon for total aniridia to
  occur during ECCE. Various reasons for their
  occurrence are as follows
• In case 1, the resident may have accidentally
  tugged on the iris with the calibri.
• In case 2, there may have been excessive pressure
  applied on the inferior limbus during nucleus
  expression.

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• Another possibility is whether or not both
  patients may have some form of intraoperative
  floppy iris syndrome (IFIS)
• In case 1, she had a small pupil intraoperatively
  and the iris in her other eye was found to be
  floppy during phacoemulsification
• In case 2, the patient was on terazosin. There is
  only one case report so far of IFIS with
  terazosin.

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Prevention

• Surgeons have to take extra care during surgery,
  especially during nucleus expression
• A good history must be taken to highlight cases
  possible IFIS
• In cases of possible IFIS, iris hooks or
  intracameral epinephrine may be useful.
• Managing the complications is important as well.