TRAUMATIC ANIRIDIA TREATED WITH ARTIFICIAL IRIS AND TRABECULECTOMY

Anterior segment reconstruction with surgical correction of traumatic aniridia aims to improve the quality of vision, compartmentalize the anterior and posterior chamber, and re-establish a satisfying cosmetic appearance. Various types of prosthetic iris devices are available, which differ in technical difficulty of implant and design. The purpose of the study is to present the clinical course of a patient with open globe trauma and traumatic aniridia. 

Department of Ophthalmology, General Hospital of Lamia, Lamia, Greece

72 years old man presented with open globe trauma (limbal rupture) and total traumatic aniridia. The patient underwent closure (suturing) of the trauma. During the follow up period the patient presented cataract which exacerbated glare in addition to vision drop. Intraocular pressure remained within normal range (12-17 mmHg). 12 months after trauma the patient underwent uneventful cataract surgery with trypan blue, dispersive OVD and capsular tension ring +one piece intraocular lens (IOL)+ artificial iris (Human Optics) in the bag insertion. 

Both glare and aesthetic outcome improved postoperatively. However, the patient presented high intraocular pressure (25mmHg under maximum tolerated topical glaucoma medication) and 6 weeks after cataract & artificial iris surgery he underwent trabeculectomy (Safe Trabeculectomy Technique) with Mitomycin C. The artificial iris implant remained stable during the postoperative period, including manipulations (suture release/removal and massage) to facilitate adequate bleb formation.

In severe ocular trauma, anterior segment reconstruction of traumatic aniridia responds to patient functional and cosmetic expectations. However, intraocular pressure rise may not be related to the prosthesis per se, but to anterior chamber angle postraumatic pathology and should be treated accordingly.