Post-traumatic Aniridia Research Articles

Modified technique for sutured scleral fixated intraocular lens in a patient with post-traumatic aniridia and aphakia: a case report

BackgroundA modified surgical technique of sutured scleral fixated intraocular lens (SSF-IOL) was applied in a patient with post-traumatic aniridia and aphakia.Case presentationA 51-year-old man was referred to our clinic with decreased vision (finger count) in his right eye. This patient had previously undergone primary repair of the ruptured globe and pars plana vitrectomy to manage ocular trauma in the same eye. On presentation, the best corrected visual acuity in his right eye was 20/40. The slit lamp examination of his right eye revealed loss of total iris and lens. Corneal endothelial cell density was 1462 cells/mm2. Fundoscopic examination of the right eye revealed a retinal attachment. For IOL implantation, a rigid poly methyl methacrylate IOL was used with a 2-point scleral fixation performed using a polypropylene suture. One year postoperatively, the uncorrected distance visual acuity was 20/32, and the manifest refraction was − 0.5/–1.5 × 130 (20/20). Pentacam revealed that the astigmatism of the anterior corneal surface and the total cornea was 1.1 D (axis: 59.8°) and 1.0 D (axis: 35.6°), respectively. The horizontal (3°–183°) cross-section image displayed an IOL with a 1° tilt and 0.425 mm decentration. The patient reported no dysphotopsia or photophobia and was satisfied with the visual results. OPD-scan III revealed that higher-order aberrations in the right eye were slightly higher than those in the left eye. No suture-related or other serious complications were observed.ConclusionThe modified SSF-IOL technique can offer improved visual quality for patients with aniridia and aphakia by ensuring proper IOL positioning and reducing astigmatism.

Клинический случай этапной хирургии последствий открытой травмы глаза

Purpose. To present a clinical case of staged surgical treatment of a patient with a battle-open eye injury. Material and methods. Patient M., born in 1976, with a condition after an open eye injury of the V degree, type B, zone II (1, 2, 3, 4, 5), with prolapse of the inner membranes, post-traumatic aniridia, post-traumatic aphakia, total hemophthalmos. From the anamnesis it is known that the patient during the shelling received several «blows» in the left side of the face. Primary surgical treatment of facial soft tissue wounds, left paraorbital area, lacerations of the upper eyelid laceration was performed. Prescribed with recommendations of conservative treatment of the left eye. The patient performed a phased surgical treatment of open eye trauma. Results. Surgical treatment was performed routinely, there were no intra- and postoperative complications. The recommended vitreoretinal and optico-reconstructive interventions ensure maximum functional, anatomical and cosmetic recovery of the operated eye. Conclusions. In stage surgical treatment of the consequences of open eye trauma, the duration of each surgical intervention is reduced. This minimizes intraoperative trauma to intraocular structures, which subsequently allows to assess the scope of optical reconstructive interventions and the need for surgical compensation of intraocular pressure. Similarly, delayed implantation of the actually required intraocular lens and iris-lens diaphragm ensures maximum refractive result and cosmetic effect. Keywords: fighting uncovered eye injury, stage-by-stage surgical treatment, optoreconstructive vitreoretinal surgery

Aniridic scleral fixation of intraocular lens: The answer to vision loss with photophobia!

Aniridia is defined as missing iris tissue which can be partial, subtotal, or total. Characteristic clinical symptoms include photophobia and decreased visual acuity due to an increased light perception. In addition to this, disturbing cosmetic problems are prevalent. Even after implantation of an intraocular lens, patients often tend to be unsatisfied. The answer to this problem lies in the implantation of an aniridic scleral fixation of intraocular lens (SFIOL), which has a central optical axis that acts as the refractive lens and a peripheral rim of a hyperpigmented area that mimics the iris and hence reduces photophobia. The purpose of the video was to demonstrate the use of black diaphragm intraocular lens (BDIOL) implantation, its surgical steps, and its outcomes. We report one such case where a young patient presented with post-traumatic aniridia with subluxated total cataract and spillover vitreous hemorrhage. He was subjected to a vitrectomy, cataract removal, and placement of an aniridic SFIOL with prolene 9-0 using the four-point fixation method. This gave an extremely gratifying outcome and solved both problems, that is, vision and photophobia. Highlight: Before implantation of the SFIOL, the patients had reduced visual acuity from aphakia and intolerable glare from aniridia. In this case-based approach and with relevant example, we tried to provide a solution for tricky scenarios like co-existing traumatic cataract and traumatic aniridia. The patient showed improved visual acuity and marked glare reduction after black diaphragm SFIOL implantation. https://youtu.be/atl60WetFsM.

Rehabilitation of patients with posttraumatic aniridia and secondary glaucoma

This study analyzes the long-term results of rehabilitation of patients with posttraumatic aniridia and glaucoma. The study included 310 patients (310 eyes) with posttraumatic aniridia who had artificial iris-lens diaphragm (ILD) MIOL-Raduzhka implanted in 2002-2022. Before ILD implantation, 61 patients (22.8%) had secondary glaucoma. Among them 35 patients (11.3%) underwent various modifications of glaucoma surgery. In 26 patients (8.6%), intraocular pressure (IOP) was compensated medically before ILD implantation. Until the third month after ILD implantation, there was a trend for IOP increase in some patients. Decompensation was noted in 8 (22.9%) out of 35 patients who had underwent glaucoma surgery. IOP decompensation was observed in 21 (80.8%) of 26 cases in patients with glaucoma compensated by drugs before ILD implantation. After ILD implantation, glaucoma appeared for the first time in 21 patients (6.8%) out of 310. In order to compensate IOP after ILD implantation, Ahmed valve implantation was performed most often - in 35 cases (70%) out of 50, deep sclerectomy - in 5 cases (10%), non-penetrating deep sclerectomy - in 4 cases (8%), micropulse transscleral laser cyclophotocoagulation (MP-TSCPC) - in 5 cases (10%), endoscopic cyclophotocoagulation (ECP) - in 1 case (2%). ILD implantation in patients with posttraumatic aniridia and secondary glaucoma should be performed with IOP compensated without hypotensive therapy and not earlier than 6-12 months after glaucoma surgery. The most optimal glaucoma surgery types in this group of patients are Ahmed valve implantation and MP-TSCPC.

Capsular bag transplantation

AbstractPurpose: To describe the surgical process of extraction of the capsular bag of the crystalline lens from the cadaveric donor and its posterior implant in aniridia and aphakia cases.Methods: This surgical procedure was used in three posttraumatic aniridia and aphakia patients, and in a aphakic case with uveitis‐glaucoma‐ hyphema (UGH) syndrome. In a case was implanted a capsular bag, an intraocular lens (IOL) and an aniridia ring. In two cases in addition was implanted an artificial iris prothesis. In three surgeries, the capsular bag was preserved by freezing prior to the operation. A pars plana vitrectomy was performed in each case. The in‐the‐bag IOL complex was fixed using a cow hitch knot technique.Results: The pseudophakic capsular bags complex remained stable and well positioned in all cases without any rejection phenomena. In the UGH syndrome, the capsular bag transplant avoided the mechanical trauma of the IOL over adjacent anatomical structures.Conclusions: Capsular bag transplant could be a good option in posttraumatic aniridia with aphakia and in UGH syndrome, to resolve these conditions in only one‐stage surgery. This new surgical technique could be the best way to recuperate the anatomical compartmentalization of the eyeball in such cases.

Клинический случай транссклеральной фиксации искусственной иридохрусталиковой диафрагмы при ее децентрации у пациента с аниридией и афакией

Purpose. To evaluate the clinical and functional results of the technique of transcleral fixation of the artificial iridochrustalic diaphragm during its decentration in a patient with aniridia and aphakia. Material and methods. Under observation was a 32-year-old patient K. with a diagnosis on the right eye: iridochrustalic diaphragm decentralization, posttraumatic aniridia, posttraumatic aphakia, who underwent a method of transcleral fixation of a displaced artificial iridochrustalic diaphragm developed at the Academician S. N. Fedorov Eye Microsurgery of the Moscow Ministry of Health of the Russian Federation. Results. Patient K. is subjectively satisfied with the visual functions obtained in the right eye. Conclusion. Thus, this clinical case demonstrates a very successful implementation of the fixation of the iridochrustalic diaphragm with its displacement to obtain satisfactory visual functions in the patient. Key words: aniridia, iridochrustalic diaphragm, transcleral fixation.

Клинический случай коррекции посттравматической афакии и аниридии

Клинический случай коррекции посттравматической афакии и аниридии

Transscleral Fixation of Black Diaphragm Intraocular Lens in Complete Aniridia and Aphakia Due to Posttraumatic Eye Rupture: A Pilot Study

Introduction: To assess long-term outcomes of implantation of black diaphragm intraocular lens (BD IOL) in post-traumatic aniridia and aphakia due to eye rupture. Methods: This is a retrospective consecutive case series of 14 eyes with post-traumatic complete aniridia and aphakia treated with scleral fixation BD IOL. Measurements included ophthalmological comorbidities, best corrected visual acuity (BCVA), complications, and postoperative interventions. The average postoperative follow-up period was 36 months. Results: BCVA improved in 6 cases, was stable in 6 cases and worsened in 2 cases. The lens was well centered in 13 cases. Glaucoma was diagnosed in six cases developed, and three of them required Ahmed valve implantation. One lens developed opacity. The cornea was decompensated in 6 cases, while two of them required penetrating keratoplasty. Conclusion: Implantation of BD IOL in eyes with severely traumatized eyes enables reconstruction of the anterior segment and some functional restoration, although many complications may arise during the longitudinal follow-up.

Clinical and theoretical substantiation of geometrical, optical and functional features of the pupil of the artificial iris

To validate the optimal biometric parameters of the pupil of artificial iris using methods of clinical and theoretical analysis. Mathematical modeling was used to determine the main criteria characterizing natural aperture diaphragm of the eye (pupil) which were considered in the theoretical substantiation of optimal biometric parameters of the AI's pupil. Parameters determined during the theoretical stage of the study were used in the development of iris-lens diaphragm (ILD) for clinical application. The study included 6 patients (6 eyes) with post-traumatic aniridia and cataract requiring reconstructive surgery. In the course of the surgery, intraocular lens and ILD were sequentially implanted into the capsular bag using injector system. The patients underwent standard and special ophthalmic examination including optical coherence tomography (OCT) of the central retina before the surgery and after 3 months. According to mathematical modeling, optimal shape of the ILD pupil was determined to be a circle. The suggested diameter for the ILD pupil is 3.2 mm. The pupil must be located on the optical axis of the eye. Distortions of the retinal image become minimal with pupil's edge thickness of 0.2 mm and cone-shaped profile. After Implantation of the developed ILD with pupil parameters determined during the theoretical substantiation, patients of the study exhibited increased visual acuity and satisfaction with results of the surgery. The biometric parameters of the ILD pupil determined during the clinical-theoretical study can be used in modern ILD models.

Scleral fixation of brown diaphragm intraocular lens in cases of posttraumatic aniridia with aphakia

Traumatic aniridia is a devastating complication of penetrating ocular injuries. Aniridia associated with aphakia can be treated with standard intraocular lens (IOL) implantation with or without scleral fixation; however, the problem of photophobia and glare remains still a concern. Although postoperative inflammation and secondary glaucoma are the main concerns, the scleral fixation of brown diaphragm IOL seems to be a good option for the management of traumatic aniridia and aphakia. Herein, we evaluated the clinical outcomes of three patients with posttraumatic aniridia who were treated with pars plana vitrectomy and scleral fixation of a brown-colored diaphragm IOL.

A new knotless technique for combined transscleral fixation of artificial iris, posterior chamber intraocular lens, and penetrating keratoplasty.

To present a new surgical technique for treating corneal opacity and aniridia with aphakia and the results in a small consecutive case series. A three-piece acrylic intraocular lens (IOL) was attached to a customized silicone iris prosthesis and fixed with three 10-0 polypropylene sutures in a knotless technique using Z-sutures after trephination of the recipient cornea. The medical records of all consecutive patients who had received a keratoplasty and an implantation of an artificial iris and IOL were reviewed. Five eyes of five patients were included in the analysis. The mean age of the patients was 46.2 years and the mean follow-up was 24.6 months. The mean best-corrected visual acuity improved from 1.36 logMAR before surgery to 0.78 logMAR after surgery during the follow-up. At the last follow-up visit, the artificial iris-IOL complex was well centered with good positioning in all cases. Management of post-traumatic aniridia combined with aphakia and corneal scars or graft failure by haptic fixation of a foldable IOL on an artificial iris combined with a simultaneous keratoplasty appears to be a promising approach, which allows to correct a complex lesion with a less traumatic and faster procedure.

Visual rehabilitation of patients with large post-traumatic defects of the anterior eye segment through iris-lens diaphragm implantation

to construct a visual rehabilitation approach to patients with post-traumatic defects of the anterior eye segment following optical-reconstructive surgery that involved implantation of an iris-lens diaphragm (ILD). We have analyzed 80 reconstructive cases with ILD implantation in patients with post-traumatic aniridia and corneal damage. These patients constituted the first study group (Group 1). We have also investigated 58 eyes with residual ametropy and stable visual function 1 year after ILD implantation before and after conducting a laser keratorefractive surgery. These patients were assigned to the second study group (Group 2). Rehabilitation approach to patients after anterior segment injuries that has been proposed allows to achieve high clinical and functional results and reduce the risk of intra- and postoperative complications. The proposed approach to patients after optical-reconstructive surgery with iris-lens diaphragm implantation followed by keratorefractive surgery is an effective method of visual rehabilitation of anterior eye segment post-traumatic defects.

Simultaneous correction of post-traumatic aphakia and aniridia with the use of artificial iris and IOL implantation

Background Combined post-traumatic aniridia and aphakia demand extensive and complex reconstructive surgery. We present our approach for simultaneous correction of this surgical situation with the use of the ArtificialIris (Dr. Schmidt Intraocularlinsen GmbH, Germany) with a foldable acrylic IOL Lentis L-313 (Oculentis, GmbH, Germany) sutured to its surface. The novelty (our first operation was on June 2010) of this surgical technique is based on the combined use of foldable (with closed haptics) IOL and Artificialiris to correct post-traumatic aniridia and aphakia.

Simultaneous correction of post-traumatic aphakia and aniridia with the use of artificial iris and IOL implantation

Combined post-traumatic aniridia and aphakia demand extensive and complex reconstructive surgery. We present our approach for simultaneous correction of this surgical situation with the use of the ArtificialIris (Dr. Schmidt Intraocularlinsen GmbH, Germany) with a foldable acrylic IOL Lentis L-313 (Oculentis, GmbH, Germany) sutured to its surface. The novelty (our first operation was on June 2010) of this surgical technique is based on the combined use of foldable (with closed haptics) IOL and Artificialiris to correct post-traumatic aniridia and aphakia. Four consecutive cases of combined post-traumatic lesions of iris and lens, corrected with complex device ArtificialIris and foldable IOL. In two cases, the compound implant was sutured to the sclera in sulcus during the penetrating keratoplasty; in another case, it was positioned through a corneal incision of about 5.0 mm with transscleral fixation, and in one patient with preserved capsular support and possibility of IOL in-the-bag implantation the ArtificialIris was placed in sulcus sutureless through a clear corneal tunnel. Maximal follow-up was 6 months. The complex device was placed firmly fixed within the sulcus, including in the eye implanted without sutures, and showed a stable and centered position without any tilt or torque. Management of post-traumatic aniridia combined with aphakia by haptic fixation of a foldable acrylic IOL on a foldable iris prosthesis appears to be a promising approach which gives the surgeon the possibility to correct a complex lesion with one procedure, which is less traumatic and faster. Existence of foldable materials, both iris and IOL, permits relatively small corneal incisions (4.0-5.0 mm). Moreover, the custom-tailored iris prosthesis gives a perfect aesthetic result.

A New Technique for Treating Posttraumatic Aniridia With Aphakia

We describe a new surgical technique for treating traumatic aniridia with aphakia and its results in a small consecutive case series. We attached a 3-piece acrylic intraocular lens through the haptics to a customized silicone iris prosthesis. The combined implant was inserted through a 5-mm incision and fixated with a transscleral suture in the ciliary sulcus using a knotless technique (Z suture). In all patients, the combined implant stayed firmly fixed within the sulcus and showed a stable and centered position without any tilt or torque during follow-up. Thus, managing posttraumatic aniridia with aphakia by means of haptic fixation of a foldable intraocular lens on a custom-tailored iris prosthesis is a promising approach for visual rehabilitation and cosmetic improvement.

Combined aniridic intraocular lens implantation and vitreoretinal surgery

A 45-year-old man presented with post-traumatic aniridia. We describe the combined surgery done to treat both aniridia and epiretinal membrane simultaneously. A combined aniridia intraocular lens and vitreoretinal surgery was done. The case report highlights the advantage of combined surgery in terms of cost factor and surgical time.

Implantation of a black diaphragm intraocular lens in ten cases of post-traumatic aniridia.

To retrospectively review the safety and efficacy of black-diaphragm intraocular lenses (IOL) implanted for the treatment of post-traumatic aniridia. Ten patients (mean age 48 years, range 21-75) were implanted with a black-diaphragm posterior chamber IOL (Morcher GmbH, model 67F) for correction of post-traumatic aniridia associated with cataract or aphakia. This IOL, in poly(methylmethacrylate), consists of an opaque diaphragm surrounding the transparent optic, and was inserted through a 10-mm scleral tunnel (seven eyes) or through the corneal trephination in cases of simultaneous penetrating keratoplasty (three eyes), and in-the-sulcus implanted, trans-sclerally sutured (six eyes) or on capsular support (four eyes). Mean follow-up was 33.4 months (range 12-52). Best-corrected visual acuity (BCVA) improved in eight eyes and remained unchanged in two. Glare and photophobia decreased in all patients. Intraoperatively, ciliary sulcus bleeding occurred in two cases and haptic rupture during lens insertion in one. Postoperatively, persistent intraocular inflammation was seen in four eyes, secondary glaucoma in four eyes, transient hyphema and/or hemovitreous in four, IOL decentration in two, and post-traumatic haptic detachment in one eye. Although in our experience the haptics still seem weak and the diaphragm diameter too large, implantation of the black-diaphragm IOL type 67F appeared sufficiently safe and provided satisfactory functional results for correction of post-traumatic aniridia combined with cataract or aphakia, improving BCVA and reducing glare and photophobia in most patients, though clearly more cases and longer follow-up are needed to assess its clinical performance properly.

A New Treatment for Photophobia in Posttraumatic Aniridia

Using staining pigments with which we had gained experience in dermatography (medical tattooing) treatments of leucoma corneae, a new approach was developed to create an artificial iris-like staining at the mid-stromal level of the cornea to treat photophobia in a patient with posttraumatic aniridia. After a central 4-mm half-depth trephination, a lamellar dissection of the corneal stroma toward the limbus was performed. A combination of colored pigments was introduced into this midstromal space, until a light blue artificial iris (to match the contralateral eye) with adequate blocking of light was created. A stable artificial iris was created in the mid-stromal level of the cornea. Dermatography pigments are stable in the corneal stroma and are useful to treat photophobia in aniridia following trauma.

Iris diaphragm implantation in post-traumatic aniridia and tractional retinal detachment.

The implantation of an artificial iris diaphragm is described in a case of aniridia and traumatic aphakia with a relapsed, tractional retinal detachment. The addition of heparin and dexamethasone to the infusion liquid is useful to reduce the fibrinous exudation which seems to be the main cause of diaphragm obliteration.