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Another challenging case: Iris loss
I learned a lot from reading the comments about the last challenging case, posted on Aug. 21. And now I'd like to get help from you about another challenging case.
 Iris defect and aphakia. |
This is an 84-year-old healthy woman who had cataract surgery of her left eye about a year ago. It was complicated by iris loss, vitreous loss and postop CME. The retina surgeon has successfully addressed her posterior segment issues and has now referred the patient for secondary IOL placement.
She is aphakic with no capsular support. A refraction of +11.50 –2.50 x 180 gives an acuity of 20/40. The K measurements are 46.00 x 90/43.00 x 180. There is a large area of sectoral iris loss, but fortunately the patient has some age-related blepharoptosis and an MRD1 measurement of 2 mm bilaterally (mean reflex distance from center of cornea to the edge of the upper eyelid is 2 mm).
The right eye has a mild cataract with a best corrected vision of 20/25 with an Rx of +1.00. The patient has failed a contact lens trial, and she wants an IOL. Optional corneal tattooing can be done also.
What's your next move?
A. No surgery. Have her try the contact lens again. There are contacts that can correct her astigmatism and even address her iris defect.
B. Place an anterior chamber IOL at an angle so that it is supported by the remaining iris. The 6-mm incision for the anterior chamber IOL could be made at 90° to address the astigmatism.
C. Suture the iris defect as best as possible, then suture a three-piece IOL to the back of the iris.
D. Suture the iris defect as best as possible, then suture a three-piece IOL transsclerally.
E. Suture the iris defect as best as possible, then place a three-piece IOL intrasclerally without sutures using the Agarwal glued technique or the Scharioth tunnel technique.
F. Something else?