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How do you approach this case?
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A 72-year-old woman presents to your office seeking help. She had cataract surgery in both eyes in another country 2 years ago. The first eye did relatively well with an uncorrected visual acuity of 20/50 and a best corrected acuity of 20/30. There's a PMMA lens in the capsular bag and a healed extracapsular incision superiorly.
 A patient wants reconstructive surgery after a poor cataract surgery result. |
She decided to proceed with surgery of the second eye after a few months. Unfortunately, things didn't go so well. The left eye has light perception vision and a PMMA lens that is captured by the iris with scarring totally blocking the visual axis and no pupil to speak of. Testing shows no afferent pupillary defect, the endothelial cell count is 1,500 cells/mm², and B-scan shows a relatively normal posterior segment with no detectable retinal pathology. She wants reconstructive surgery for this left eye.
The photo shows the challenge: The iris is atrophic, scarred and non-mobile; the PMMA lens is entangled in iris and fibrous scar tissue; there is likely minimal or no capsular support remaining; and extraction of the PMMA lens will require a large incision. What is your surgical plan?