Phacoemulsification and IOL Implantation in an Iris Coloboma Case

We present a case of cataract extraction and intraocular lens implantation in an eye with a congenital iris coloboma.

A 1.2 mm side-port blade is used to make a corneal incision. A mixture of epinephrine 2% and lidocaine 1% is injected into the anterior chamber. Viscoelastic is injected to maintain the anterior chamber. A 2.4 mm keratome blade is used to make a clear corneal incision at the temporal limbus. Iris synechiolysis is performed using a visco cannula. Two iris hooks are placed superiorly to enlarge the pupil. A continuous circular capsulorhexis is performed using a cystotome. Hydrodissection is performed with injection of balanced saline solution. A divide and conquer technique is initiated. Difficulty in rotation was encountered; therefore, balanced saline solution and viscoelastic were placed underneath the lens to anteriorly prolapse the nucleus. Then, a supracapsular technique was initiated. A Drysdale instrument and an ambidextrous chopper are used to mechanically disassemble the nucleus. The nucleus is removed using a phacoemulsification hand-piece. The irrigation and aspiration hand-piece is used to remove the cortex from the capsular bag. The next step is injection of viscoelastic. Then, the PCIOL is injected. A Kuglen hook and a Sinskey instrument are both used to facilitate proper positioning of the PCIOL. The iris hooks are then removed. Viscoelastic is removed using the irrigation and aspiration hand-piece. The wounds are sealed with balanced saline solution. The wounds and the intraocular pressure are checked with a Weck-Cel.
Cataract surgery is indicated when patients experience blurred vision that interferes with their lifestyle.
Extracapsular cataract extraction may be preferred over phacoemulsification in patients with very dense cataracts, compromised corneal endothelium, or loose zonules.
The patient was positioned supine in the operating room. A proparacaine hydrochloride 0.5% eye drop, betadine (povidone-iodine 5%) antiseptic drops, and lidocaine ophthalmic gel (topical anesthesia) were applied to the operative eye. The periocular area was prepped with betadine. Sterile drapes were placed over the face and head in the usual fashion for intraocular surgery. An eyelid speculum was placed in the eye to keep the eyelids open during the procedure. The patient received mild intravenous sedation during the surgery.
The preoperative work-up entails obtaining a history of present illness, complete ocular and medical history, and a dilated physical examination of the eyes. During the clinical examination, our patient was found to have a cataract as well as an iris coloboma in the right eye. Pre-operative measurements were obtained in clinic.
The congenital iris coloboma was located inferiorly in the patient's right eye.
Cataract extraction and intraocular lens implantation is a short, effective and safe surgery.
There is a risk of zonular instability and rupture with lens subluxation and vitreous loss. There is a small risk (0.1%) of infection with cataract surgery.
1. Onwochei BC, Simon JW, Bateman JB, Couture KC, Mir E. Ocular colobomata. Surv Ophthalmol. 2000;45(3):175-194. doi:10.1016/s0039-6257(00)00151-x. 2. Kohli G, Shah C, Sen A, et al. Cataract surgery in eyes with associated coloboma: Predictors of outcome and safety of different surgical techniques. Indian J Ophthalmol. 2021;69(4):937-945. doi:10.4103/ijo.IJO_2276_20. 3. Phylactou M, Matarazzo F, Day AC, Hussain B, Maurino V. Cataract surgery in eyes with congenital ocular coloboma. Graefes Arch Clin Exp Ophthalmol. 2020;258(12):2753-2759. doi:10.1007/s00417-020-04915-1.

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