Iris trauma in a highly myopic woman with one functional eye October consultation #1.

Abstract

A 58-year-old highly myopic woman had suffered a windscreen trauma to her left eye during a car accident 40 years earlier. Reportedly, iris tissue was removed in emergency surgery. Her right eye has very poor vision with only hand motion perception due to myopic maculopathy. The myopia of -12 diopters (D) in her left eye is corrected with a hard contact lens, which is well tolerated. With the contact lens and an additional spectacle correction of -1.5 D, visual acuity is 0.5 Jg1. Slitlamp biomicroscopy reveals a lacerated iris with iridodialysis extending along the superior circumference from 8:30 to 4:30 o'clock and a superior-temporal pupil coloboma. The disinserted and contracted iris tissue resides on the anterior lens surface (Figure 1). The residual pupil is slightly decentered inferiorly and still reactive to light. The lens zonular fibers are intact along the full and particularly the superior circumference. Slitlamp illumination reveals grade 2 cataract formation in nucleus center. Intraocular pressure is 12 mm Hg. The central retina shows myopic tabulation with intact macula.During the past 6 months, the patient has been experiencing increasing shortsightedness and light sensitivity, especially outdoors, and desires cataract surgery. Given this is the only eye with reading capacity, which would be your surgical options and preferred approach to treat the cataract and remedy the traumatized iris?