A 25-year-old woman with history of idiopathic chronic panuveitis in her childhood had been submitted to extracapsular cataract extraction (right eye at 8 years and left eye at 6 years) and has been followed up in our institution since she was 12 years old. During this period, she experienced repeated mild iridocyclitis crises, controlled with the use of topical corticosteroids or nonsteroidal antiinflammatory drugs (NSAIDs). At 12 years of age, the corrected distance visual acuity was 20/30 in the right eye (+13.50 −1.00 × 170) and 20/20 in the left eye (+13.75 −1.25 × 160).
Because of bilateral chronic cystoid macular edema, by age 25 her visual acuity had declined to 20/50 in the right eye and 20/60 in the left eye (Figure 1). After several years, she developed intolerance to the use of soft contact lenses, especially in the left eye. Because the patient had no recurrence of uveitis for the last 10 years, the possibility of secondary IOL implantation was considered.
Considering that she has a severe iridocapsular synechia and surgical dissection would lead to trauma and postoperative inflammation, what would be your possible surgical solutions?