Ocular Trauma Caused Mydriasis and Lens Subluxation Management With Yamane Fixation and Iris Cerclage Techniques: A Case Report [Conference Winner Abstract]

Abstract

Introduction Acute vision loss can occur due to the eye trauma or its complications, such as lens subluxation, that can cause not only poor vision, but also glaucoma (1,2). Pupillary sphincter muscle tearing is also common and can result in dilated pupil and diminished reactivity to light (3). This case report depicts the importance of timely response, and an appropriate treatment of ocular trauma caused conditions. Case Presentation A 77-year-old woman presented with impaired vision and painful left eye (LE). Three months ago, she fell from the ladder and injured her head and LE. Patient went to the emergency department and during the examination uncorrected distance visual acuity (UDVA) was 6/120, intraocular pressure (IOP) - 40 mmHg. Shallow LE anterior chamber, traumatic mydriasis, phacodonesis and lens subluxation were observed. Computed tomography (CT) showed no changes. Patient went to the hospital for urgent consultation and due to deteriorating visual acuity, increased IOP - 54,2 mmHg, subluxated lens, traumatic mydriasis and loss of retinal nerve fiber layer (RNFL) in optical coherent tomography (OCT), emergency surgical treatment was planned and IOP treatment was prescribed. Patient underwent LE full pars plana vitrectomy, with subluxated lens phacofragmentation. Then 3 piece intraocular lens (IOL) was implanted and fixated using modified Yamane technique. After IOL implantation pupil diameter remained >7 mm., due to high risk of pupillary capture, iridoplasty by iris cerclage technique was performed. Two weeks later LE IOP was 14,6 mmHg, UDVA - 6/200, flanges were in scleral tunnels under tenon and conjunctiva, cornea was clear, pupil – formed, 3,5-4 mm diameter, IOL was in posterior chamber, well centered. Although, LE IOP decreased post-operatively, UDVA remained similar as before surgery due to loss of RNFL. Discussion Ocular injuries can cause permanent vision loss if they are not recognized and treated promptly (4). Although, appropriate surgical treatment is important in preventing poor prognosis, time to treatment is crucial in the ultimate visual outcome (4,5). Conclusions Ocular trauma caused conditions, especially high IOP, have to be treated with urgency, appropriate medical and surgical techniques (2,3,6,7). Timely response is crucial for avoidance of ocular trauma sequelae and further visual acuity loss (5).