|Year : 2019 | Volume
| Issue : 2 | Page : 170-172
Iridocele, total aniridia, and subconjunctival pseudomelanosis following blunt ocular trauma: An interesting case report with a new finding
Isha Agarwalla, Harsha Bhattacharjee, Dipankar Das, Diva Kant Misra
Department of Ocular Pathology, Sri Sankaradeva Netralaya, Guwahati, Assam, India
|Date of Web Publication||10-Sep-2019|
Dr. Isha Agarwalla
Department of Ocular Pathology, Sri Sankaradeva Netralaya, Beltola, Guwahati, Assam
Source of Support: None, Conflict of Interest: None
A patient presented with traumatic globe rupture, pseudomelanosis of the conjunctiva, total traumatic aniridia, and subconjunctival iridocele, which was detected following wound exploration. This visually devastating condition of traumatic aniridia, iridocele, and melanosis with complete iris tissue extraction from the anterior chamber is reported for the first time.
Keywords: Aniridia, anterior chamber, iridocele, pigment dispersion, pseudomelanosis, trauma
|How to cite this article:|
Agarwalla I, Bhattacharjee H, Das D, Misra DK. Iridocele, total aniridia, and subconjunctival pseudomelanosis following blunt ocular trauma: An interesting case report with a new finding. TNOA J Ophthalmic Sci Res 2019;57:170-2
|How to cite this URL:|
Agarwalla I, Bhattacharjee H, Das D, Misra DK. Iridocele, total aniridia, and subconjunctival pseudomelanosis following blunt ocular trauma: An interesting case report with a new finding. TNOA J Ophthalmic Sci Res [serial online] 2019 [cited 2019 Nov 17];57:170-2. Available from: http://www.tnoajosr.com/text.asp?2019/57/2/170/266394
| Introduction|| |
Total iridodialysis or sectoral and diffuse iris rupture following trauma has been reported before, which is usually associated with globe rupture or dehiscence of the site with lowest resistance, but total aniridia with complete 360 iris tissue following blunt trauma has never been reported. Traumatic aniridia is never an isolated condition and is often associated with injury to the other structures of the eye. Blunt ocular trauma can present with a spectrum of manifestations depending upon the site injured and the intensity of trauma.
Here we describe a patient with a history of blunt ocular trauma who presented pseudomelanosis of the conjunctiva, isolated total traumatic aniridia, and subconjunctival iridocele, which was detected following wound exploration without damage to other intraocular structures after blunt trauma to the eye.
| Case Report|| |
A 45-year-old male reported with dimness of vision, visual glare, and blackish discoloration of the left eye following blunt trauma 2 months back, for which he received conservative treatment elsewhere. On examination, the best-corrected visual acuity was 6/6 and 6/36 in the right and left eye, respectively. Slit-lamp examination revealed 360° bulbar conjunctival melanotic discoloration excepting nasal and temporal patches at 180° meridian and a cystic lesion located inferiorly. 36° pseudomelanosis of conjunctiva was noted, except a patch of uninvolved bulbar conjunctiva nasally and temporally at 180 meridian [Figure 1]. Posterior segment examination revealed vitreous hemorrhage. The right eye was normal.
|Figure 1: 360° aniridia with conjunctival pseudomelanosis. (A) Showing prominent scleral vessels; (B) Conjunctival pseudomelanosis; (C) limbal–scleral wound site with cystic lesion|
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On exploration, a 4-mm long horizontal globe dehiscence was noted at 6 o clock position in the limbal–scleral junction. A black circular mass of tissue was dissected from inside of the cystic swelling [Figure 2]. The wound was sutured.
|Figure 2: Intra-operative wound exploration with primary repair of the wound site revealed cystic iris tissue adjacent to the wound site with iris pigment dispersion. (A) Wound site and adjacent cystic swelling|
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The cystic lump was examined in the ocular pathology laboratory which revealed a 360° florid iris tissue where severed iris root and the pupil both could be demonstrated [Figure 3]. Histopathological examination (using ZEISS Axioscope, MRC, Germany) detected typical iris polygonal cells containing melanocytic pigment granules and melanocytes with prominent nuclei [Figure 4]. The dividing cells were smaller with scanty pigment, whereas stationary cells were larger with dense pigment granules on enhanced magnification [Figure 5]. These clinical and histopathological findings confirmed the diagnosis of traumatic iridocele, aniridia, and conjunctival pseudomelanosis. The postoperative period was uneventful with best-corrected visual recovery of 6/18 and persistent pseudomelanosis. Plano phakic aniridia intraocular lens (IOL) implantation has been planned.
|Figure 3: (A and B) 360 florid iris tissue with severed iris root and the pupil could be demonstrated|
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|Figure 4: Typical pigment epithelial cells are polygonal, contain pigment granules. Melanocytes noted were smaller with prominent nuclei. (A)Melanocytes cells; (B) Spindle shaped pigment epithelial cells|
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|Figure 5: Dividing cells with diluted pigment, stationary cells were larger with dense pigment granules. (A) Dividing cells; (B) Stationary cells|
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| Discussion|| |
Open-globe accidental blunt trauma is a major medical, epidemiological, and economic concern due to severe vision loss that follows. The blunt trauma can give rise to globe rupture at the limbus, ocular hypotony, aniridia, iridodialysis, cyclodialysis, and other anterior and posterior segment manifestations depending on the gradient of trauma., In our case following trauma, complete mass of iris tissue was noted in the subconjunctival space due to avulsion of iris tissue from its base and pupillary miosis., Previous reports of traumatic aniridia have been recorded with globe rupture in pseudophakic eyes following phacoemulsification through the incision site, thereby leading to expulsion of iris tissue, and in some cases, IOL was under the subconjunctival space. Merritt et al. reported extensive conjunctival pigmentation noted in the trabeculectomy bleb site, and it leads to a concern of neoplasm and pigment dispersion. Pigmented conjunctival lesion may develop following various infective, inflammatory, and traumatic conditions even following various retained foreign body including a pencil tip which may mimic conjunctival melanosis., Histopathological examination of the present case revealed possible viability of iris tissue in the subconjunctival location, as capacity of mitosis of pigment cell was retained even after disturbance of the physiological niche.
The visual glare in traumatic aniridia can be treated by colored contact lens, corneal tattooing, and iris reconstruction implants. Extensive PubMed search using keywords: pseudomelanosis, pigment dispersion, iridocele, total aniridia, and subconjunctival pseudomelanosis, we could not find any published literature with the above mentioned keywords following blunt ocular trauma. Moreover, the clinical and microscopic finding of total iris tissue retrieved from the subconjunctival location has been reported for the first time. Above all, it will be interesting to note any sympathetic ophthalmitis developing in the other eye in the future. Considering the rarity, this case has been reported.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]