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Isolated traumatic aniridia after trabeculectomy in a pseudophakic eye.

Kaliaperumal S, Troutbeck R, Iemsomboon W, Farinelli A - Indian J Ophthalmol (2014)

Bottom Line: The cupping was 0.8, and the rest of the fundus and macula were normal.Gonioscopy revealed only faint pigments at the fistula.The mechanism and the management of the glaucoma are discussed.

View Article: PubMed Central - PubMed

Affiliation: Department is glaucoma unit, Sydney Eye Hospital, Sydney, NSW-2145, Australia, .

ABSTRACT
This is a single case report of an elderly patient who had blunt trauma in an eye that had phacoemulsification and two trabeculectomies. She had good vision with a well-functioning bleb before the trauma. She presented during her routine follow-up visit for glaucoma with isolated aniridia and an intact globe. The capsular bag, zonules, and the intraocular lens were intact. The cupping was 0.8, and the rest of the fundus and macula were normal. Pigments were seen over the sclera extending posteriorly upto the fornix. Gonioscopy revealed only faint pigments at the fistula. Following the trauma, the intraocular pressure had increased to 26 mm Hg. The mechanism and the management of the glaucoma are discussed.

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OD showing the complete absence of brown iris with intact opacified capsular bag and intraocular lens (optic and haptic) and remnant iris pigments stuck to capsulotomy margin
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Figure 1: OD showing the complete absence of brown iris with intact opacified capsular bag and intraocular lens (optic and haptic) and remnant iris pigments stuck to capsulotomy margin

Mentions: A 70-year-old Chinese lady attended the glaucoma clinic during routine follow up in November 2007. She had undergone trabeculectomies with 5FU OU in 1998 for primary open angle glaucoma and phacoemulsification OD with foldable IOL implantation (SA60AT) through a 2.8-mm corneal tunnel in 2003. In 2005, she had a repeat trabeculectomy with MMC and a needling procedure OD. In her previous visits, the bleb in OD was thin, minimally vascular with slight elevation, and the intraocular pressure (IOP) was maintained at 12–15 mmHg (applanation tonometer), the iris was normal, and the best-corrected visual acuity was 20/30. The cupping in OD was noted to be 0.65 with inferior neuroretinal rim thinning. Fast retinal nerve fiber thickness analysis by optical coherence tomography showed similar inferior thinning with thickness in other quadrants in normal range. The Humphrey field analysis (24-2) showed a superior nasal step. When she presented in November 2007, the best-corrected visual acuity was 20/40 in OD and 20/30 in OS and the IOP was 26 mmHg and 16 mmHg OD and OS, respectively. The cornea was strikingly clear, the corneal wound appeared intact, and the chamber was deep. Surprisingly, the iris was completely absent and the posterior chamber intraocular lens with the opacified intact capsular bag was visible in its entire extent [Fig. 1]. Few remnants of iris tissue were stuck to the nasal anterior capsulotomy margin. The bleb was almost flat with some vascularization, and the underlying sclera was pigmented and the pigmentation extended posteriorly upto the fornix [Fig. 2]. On questioning about possible trauma, the patient revealed that she sustained injury OD 4 months ago by hitting against the edge of a table back in China. She had pain and decreased vision following the injury for which topical medications where started but could not provide further details although no intervention was done. Gonioscopy showed no signs of angle recession; faint pigments were found at the second sclerostomy opening/fistula and none at the previous fistula. Dilated fundus examination revealed 0.8 cup with superior and inferior thin rims but healthy retina and macula OD. The field defect had increased to a superior arcuate scotoma. There was a functioning bleb with normal iris OS. She was started on latanoprost eye drops OD, but since adequate control was not achieved, Baerveldt tube surgery was subsequently performed.


Isolated traumatic aniridia after trabeculectomy in a pseudophakic eye.

Kaliaperumal S, Troutbeck R, Iemsomboon W, Farinelli A - Indian J Ophthalmol (2014)

OD showing the complete absence of brown iris with intact opacified capsular bag and intraocular lens (optic and haptic) and remnant iris pigments stuck to capsulotomy margin
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4061689&req=5

Figure 1: OD showing the complete absence of brown iris with intact opacified capsular bag and intraocular lens (optic and haptic) and remnant iris pigments stuck to capsulotomy margin
Mentions: A 70-year-old Chinese lady attended the glaucoma clinic during routine follow up in November 2007. She had undergone trabeculectomies with 5FU OU in 1998 for primary open angle glaucoma and phacoemulsification OD with foldable IOL implantation (SA60AT) through a 2.8-mm corneal tunnel in 2003. In 2005, she had a repeat trabeculectomy with MMC and a needling procedure OD. In her previous visits, the bleb in OD was thin, minimally vascular with slight elevation, and the intraocular pressure (IOP) was maintained at 12–15 mmHg (applanation tonometer), the iris was normal, and the best-corrected visual acuity was 20/30. The cupping in OD was noted to be 0.65 with inferior neuroretinal rim thinning. Fast retinal nerve fiber thickness analysis by optical coherence tomography showed similar inferior thinning with thickness in other quadrants in normal range. The Humphrey field analysis (24-2) showed a superior nasal step. When she presented in November 2007, the best-corrected visual acuity was 20/40 in OD and 20/30 in OS and the IOP was 26 mmHg and 16 mmHg OD and OS, respectively. The cornea was strikingly clear, the corneal wound appeared intact, and the chamber was deep. Surprisingly, the iris was completely absent and the posterior chamber intraocular lens with the opacified intact capsular bag was visible in its entire extent [Fig. 1]. Few remnants of iris tissue were stuck to the nasal anterior capsulotomy margin. The bleb was almost flat with some vascularization, and the underlying sclera was pigmented and the pigmentation extended posteriorly upto the fornix [Fig. 2]. On questioning about possible trauma, the patient revealed that she sustained injury OD 4 months ago by hitting against the edge of a table back in China. She had pain and decreased vision following the injury for which topical medications where started but could not provide further details although no intervention was done. Gonioscopy showed no signs of angle recession; faint pigments were found at the second sclerostomy opening/fistula and none at the previous fistula. Dilated fundus examination revealed 0.8 cup with superior and inferior thin rims but healthy retina and macula OD. The field defect had increased to a superior arcuate scotoma. There was a functioning bleb with normal iris OS. She was started on latanoprost eye drops OD, but since adequate control was not achieved, Baerveldt tube surgery was subsequently performed.

Bottom Line: The cupping was 0.8, and the rest of the fundus and macula were normal.Gonioscopy revealed only faint pigments at the fistula.The mechanism and the management of the glaucoma are discussed.

View Article: PubMed Central - PubMed

Affiliation: Department is glaucoma unit, Sydney Eye Hospital, Sydney, NSW-2145, Australia, .

ABSTRACT
This is a single case report of an elderly patient who had blunt trauma in an eye that had phacoemulsification and two trabeculectomies. She had good vision with a well-functioning bleb before the trauma. She presented during her routine follow-up visit for glaucoma with isolated aniridia and an intact globe. The capsular bag, zonules, and the intraocular lens were intact. The cupping was 0.8, and the rest of the fundus and macula were normal. Pigments were seen over the sclera extending posteriorly upto the fornix. Gonioscopy revealed only faint pigments at the fistula. Following the trauma, the intraocular pressure had increased to 26 mm Hg. The mechanism and the management of the glaucoma are discussed.

Show MeSH
Related in: MedlinePlus