CONQUER EACH BATTLE: A STEPWISE APPROACH TO A SUNRISE SYNDROME AFTER COMPLICATED CATARACT SURGERY

To report our surgical intervention and outcomes in a patient who presented with Sunrise Syndrome of a 1-piece Intraocular Lens (IOL) sutured on the iris, anterior synechiae, an iatrogenic iris defect and a Capsular Tension Ring (CTR) left after the first complicated cataract surgery.

Department of Ophthalmology, Hippokrateio General Hospital of Thessaloniki, Thessaloniki, Greece

Surgical intervention was performed on a patient with a subluxated 1-piece posterior chamber IOL. The one haptic was sutured to the iris at the 5 o’clock position and the other haptic was unsupported, likely due to suture breakage, resulting in Sunrise Syndrome. Anterior synechiae were noted at the 3 o’clock position. Under sub-Tenon anesthesia, anterior vitrectomy was performed using triamcinolone acetate for visualization of the vitreous. A retained CTR was identified at this point and removed with forceps. The suture securing the 5 o’clock haptic to the iris was cut with vitrectomy scissors, allowing the IOL to be elevated above the iris for support. The initially unsupported haptic was externalized through the main incision at 12 o’clock, and a straight cut was made with scissors, extending up to two-thirds of the optic segment, facilitating the explantation of the IOL. Centripetal mechanical pulling was applied to the iris, stretching it and breaking the anterior synechiae. A three-piece IOL was then fixated intrasclerally using 25G trocars. Finally, a single-pass four-throw pupilloplasty was performed at the 3 o’clock iris margin to restore the shape of the pupil, followed by intracameral injection of antibiotics and subconjunctival corticosteroid injection.

Good anatomical restoration and improved visual acuity were achieved. During the initial follow-up visits, the patient was monitored at a regional hospital. At the six-week follow-up in our department, visual acuity had improved from Hand Motion (HM) to 0.3 LogMAR (0.5 Decimal). Irvine-Gass Syndrome was identified at this time and treated with intravitreal triamcinolone.

As seen in this case, cataract surgery can rarely lead to significant complications. After the initial surgery, which involved zonular dehiscence and the insertion of a CTR, followed by a second surgery where a 1-piece IOL was sutured to the iris, the patient presented to our department for further treatment. We successfully addressed the above issues, achieving both good anatomical restoration and improved visual acuity. This case highlights that even surgeries perceived as complex, can have successful outcomes when a stepwise surgical approach is employed.