|Year : 2021 | Volume
| Issue : 1 | Page : 110-111
Rare traumatic expulsion of the iris presenting as aniridia
Bharat Gurnani, Josephine Christy, Kirandeep Kaur, Fredrick Mouttappa
Department of Cornea and Paediatric Ophthalmology, Aravind Eye Hospital, Puducherry, India
|Date of Submission||19-Nov-2020|
|Date of Acceptance||01-Jan-2021|
|Date of Web Publication||27-Mar-2021|
Dr. Josephine Christy
Aravind Eye Hospital, Puducherry - 605 007
Source of Support: None, Conflict of Interest: None
A 55 year old male presented with pain and defective vision in left eye following blunt trauma with sugarcane stick. Anterior segment examination revealed periorbital edema, circumcorneal congestion, ruptured sclerocorneal tunnel with 360 iridodilaysis and iris extrusion through the scleral tunnel, corneal edema, blood staining of endothelium, anterior chamber was flat with eight ball hyphema and vitreous prolapse. A corneoscleral repair was performed with iris abscission, Intraocular lens explantation, anterior vitrectomy and anterior chamber reformation. Postoperative day 1 patient had well opposed sutured scleral tear, corneal edema with descemet membrane folds, anterior chamber hyphema, fibrinous membrane with blood clot over iris and aphakia. B-scan revealed 360 degree hemorrhagic choroidal detachments, retinal detachment with vitreous hemorrhage.
Keywords: Aniridia, expulsion, traumatic
|How to cite this article:|
Gurnani B, Christy J, Kaur K, Mouttappa F. Rare traumatic expulsion of the iris presenting as aniridia. TNOA J Ophthalmic Sci Res 2021;59:110-1
|How to cite this URL:|
Gurnani B, Christy J, Kaur K, Mouttappa F. Rare traumatic expulsion of the iris presenting as aniridia. TNOA J Ophthalmic Sci Res [serial online] 2021 [cited 2021 May 6];59:110-1. Available from: https://www.tnoajosr.com/text.asp?2021/59/1/110/312303
| Introduction|| |
Ocular trauma is one of the common causes of visual impairment. Appropriate and timely ocular surgeries with meticulous management and regular follow-up can improve final visual acuity and salvage the eye. The detachment of the iris root from its attachment at the ciliary body results in iridodialysis. The most common cause is ocular trauma, followed by complicated intraocular surgery, and rarely, spontaneous or congenital variety is also noted.,
| Case Report|| |
A 55-year-old male presented with pain and defective vision in the left eye following blunt trauma with sugarcane stick. The best-corrected visual acuity in the right eye was 6/9 and the left eye was perception of light. Intraocular pressure measured by noncontact tonometry was 14 mmHg in in right eye and non recordable in left eye. Anterior segment examination revealed periorbital edema, circumcorneal congestion, ruptured sclerocorneal tunnel with 360 iridodialysis and iris extrusion through the scleral tunnel, corneal edema, blood staining of endothelium, anterior chamber was flat with eight-ball hyphema and vitreous prolapse [Figure 1]. The remaining anatomical details were obscured. There was a history of bilateral cataract surgery 6 months previously. A soft globe with leaking aqueous was detected using Seidel test, where 1% fluorescein is applied to the ocular surface and the leak was detected with cobalt blue filter. A corneoscleral repair was performed with iris abscission, intraocular lens explantation, anterior vitrectomy, and anterior chamber reformation [Figure 2]. The prognosis was guarded due to the risk of retinal detachment, choroidal detachment, endophthalmitis, and need for multiple surgeries.
|Figure 1: Image of the left eye of the patient depicting periorbital edema, circumcorneal congestion, ruptured sclerocorneal tunnel with 360 iridodialysis and iris extrusion through the scleral tunnel, corneal edema, blood staining of endothelium, flat anterior chamber with eight-ball hyphema, and vitreous prolapse|
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|Figure 2: Postoperative image of the patient depicting well-opposed sutured scleral tear, corneal edema with Descemet membrane folds, anterior chamber hyphema, fibrinous membrane with blood clot over iris, and aphakia|
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Postoperative day 1, the patient had well-opposed sutured scleral tear, corneal edema with Descemet membrane folds, anterior chamber hyphema, fibrinous membrane with blood clot over iris, and aphakia. B-scan was suggestive of vitreous hemorrhage. On follow-up on day 15, the clinical condition was better and inflammation and vitreous hemorrhage was resolving. Hence, the patient was managed conservatively with topical steroids and cycloplegics. On follow-up at 1 month postoperatively, the patient had visual acuity of 5/60 with +10 D lens with aphakia. Further, the patient was advised follow-up at 3 months.
| Discussion|| |
Ocular trauma may be due to mechanical trauma (blunt or penetrating), chemical agents, or radiation (ultraviolet or ionizing). It is the leading cause of visual loss that frequently affects young people. Mechanical ocular injuries can be classified as open and closed globe injuries, according to the Birmingham Eye Trauma Terminology System. Injuries associated with ocular trauma include globe rupture, globe laceration, penetrating trauma, perforating trauma, blowout fracture of the orbit, and muscular entrapment. Iris prolapse may occur after surgery (cataract and corneal transplant), following trauma (corneal laceration and scleral laceration), through a perforated corneal ulcer, or through a corneal melt associated with rheumatoid arthritis. Traumatic expulsive iridodialysis is a rare complication after trauma by a blunt object in eyes with previous small-incision cataract surgery. Management is by immediate surgical closure of the corneoscleral tear or perforation. Occasionally, further abscission of the iris is required to salvage the globe. Prompt management reduces the chances of endophthalmitis, retinal and choroidal detachment, sympathetic ophthalmia, and phthisis bulbi.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initial 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.
| References|| |
Négrel AD, Thylefors B. The global impact of eye injuries. Ophthalmic Epidemiol 1998;5:143-69.
Kuhn F, Morris R, Witherspoon CD. Birmingham eye trauma terminology (BETT): Terminology and classification of mechanical eye injuries. Ophthalmol Clin North Am 2002;15:139-43, v.
Misra S, Nandwani R, Gogri P, Misra N. Clinical profile and visual outcome of ocular injuries in a rural area of western India. Australas Med J 2013;6:560-4.
Zurutuza A, Andonegui J, Berástegui L. Traumatic expulsive iridodialysis with vitreous prolapse. Int Ophthalmol 2011;31:469-70.
Saleh M. Ocular trauma. Blunt ocular trauma. J Fr Ophtalmol 2012;35:445-53.
[Figure 1], [Figure 2]