CATARACT SURGERY IN A PATIENT WITH EXTENSIVE POST-TRAUMATIC IRIDOCORNEAL ADHESION.

This report describes cataract surgery in a 65-year-old male with extensive iridocorneal adhesion due to trauma 20 years ago.

Department of Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland;

The patient presented to our outpatient clinic with worsening vision in the left eye. Visual acuity in the right eye was 0.5, and in the left eye, 0.02. Intraocular pressure was normal. A slit-lamp examination of the anterior segment revealed an extensive corneal scar, adjacent iridocorneal adhesion, and a mature cataract in the left eye. Optical coherent tomography (OCT) CASIA II (Tomey Corporation, Japan) confirmed extensive iridocorneal adhesion. Due to the corneal scar, OCT helped to assess the exact location and extent of the adhesion.

During cataract surgery, iris hooks were used due to a lack of pupil dilation, while the extensive paracentral adhesion was left intact.

Although the capsulorhexis was small and decentred, it allowed for the safe removal of the complicated cataract and the implanting of the intraocular lens (IOL) into the bag. The visual acuity of this eye was 0.3 the day after surgery and 0.5 two weeks later.

Iridocorneal adhesion presents significant surgical challenges, particularly during cataract procedures. These adhesions restrict access to the anterior chamber, increasing the risk of iris trauma and limiting instrument maneuverability. Releasing the adhesions can lead to corneal edema, endothelial cell damage, and potential inflammatory responses, complicating postoperative recovery. Visualization of the surgical field may be compromised, making precise cataract removal and IOL placement more difficult. As a result, specialized techniques and careful planning are essential to minimize complications and achieve successful outcomes in cases with extensive iridocorneal adhesion.