Aniridia occurs congenitally and traumatically. Recently, black-diaphragm intraocular lens (IOL) implantation has been reported to provide good functional and cosmetic results.1,2 In special cases, however, routine posterior chamber IOL (PCIOL) implantation is reasonable.3 We report a case of traumatic loss of iris and formation of a fibrous membrane at the lens plane in which a PCIOL was implanted combined with a transchamber suture, and good results were obtained.
A 64-year-old woman had cataract extraction in the left eye at a private clinic in July 1995. In August 1995, she was struck in the left eye with a fist and presented to the emergency room of Chonnam University Hospital 2 days later. Her visual acuity was 10/20 in the right eye and hand movements in the left. Intraocular pressure (IOP) was 6 mm Hg in the injured left eye, with a hyphema and a vitreous hemorrhage. The previously implanted PCIOL and iris were prolapsed through the corneoscleral portion of the cataract wound, although the conjunctiva remained intact. The prolapsed iris and the PCIOL were surgically removed, and the wound was closed.
By October 1996, a cicatricial membrane had developed at the lens plane (Figure 1), and the best corrected visual acuity in the left eye was 4/20. Secondary PCIOL implantation on the fibrous membrane was performed, a triangular transchamber suture was made with 10-0 polypropylene, and the central fibrous membrane was removed. Three years later, the patient maintained a visual acuity of 10/20 and IOP of 16 mm Hg in both eyes without complications or complaints (Figure 2).
In aniridia, routine PCIOL implantation can induce several problems: glare, touch of PCIOL–corneal endothelium, and cosmetic problems. Recently, black-diaphragm IOL implantation has been recommended with a large scleral wound. In this case, however, a fibrous membrane at the lens plane was used to support the PCIOL and as a substitute for the pupil to decrease glare. We also made a triangular transchamber suture, similar to one described by Simcoe,4 to prevent possible PCIOL–corneal touch and enhance the stability of the PCIOL. A long needle with a 10-0 polypropylene suture was inserted through the sclera about 1.0 mm from the superonasal corneoscleral limbus; it was passed through the anterior chamber and pierced the superotemporal sclera in an in–out direction. The needle was reinserted in an out–in direction at the sclera 0.5 mm from the previous site to inferior sclera, passed through the anterior chamber, and pierced through inferior sclera in an in–out direction. This maneuver was repeated from the inferior to the original superonasal area, and each end of the 10-0 polypropylene suture was tied. The procedure was simple and effective, and the fibrous membrane and corneal endothelial cells were maintained well without an increase in IOP or uveitis.
In conclusion, routine PCIOL with a triangular transchamber suture poses no problem in special cases of aniridia, and use of a triangular transchamber suture is simple and effective.
1. Thompson CG, Fawzy K, Bryce IG, et al. Implantation of a black diaphragm intraocular lens for traumatic aniridia. J Cataract Refract Surg 1999; 25:808-813
2. Sundmacher R, Reinhard T, Althaus C. Black-diaphragm intraocular lens for correction of aniridia. Ophthalmic Surg 1994; 25:180-185
3. Johns KJ, O'Day DM. Posterior chamber intraocular lenses after extracapsular cataract extraction in patients with aniridia. Ophthalmology 1991; 98:1698-1702
4. Simcoe CW. An ounce of prevention. Am Intra-Ocular Implant Soc J 1978; 4(1):39-44