CHALLENGING MANAGEMENT OF TRAUMATIC POSTERIOR LENS LUXATION WITH ANIRIDIA: A CASE REPORT

Abstract

This case report demonstrates the challenging condition and management of a patient with aphakia due to posterior lens luxation and aniridia, following a blunt trauma. The patient is a 34-year-old male with blurred vision on right eye. He had a history of blunt trauma 1.5 years prior, that resulted in corneoscleral laceration and hyphema, then underwent surgery at the time of injury. In present time, 1.5 years after the right eye trauma and surgery, the visual acuity was 6/40 cc S+7.00 C-4.00 X120 -> 6/7.5 with normal intraocular pressure. Anterior segment of present right eye showed 2 remaining corneal sutures and slight neovascularization outside of visual axis. There was an absence of iris and lens on right eye, but there were visible remains of anterior capsule peripherally and vitreous body in the center. Posterior segment of right eye showed posterior lens luxation on the inferior, with retina, macula and optic nerve head within normal condition, confirmed by OCT findings. Left eye was unremarkable. The patient was diagnosed with right eye posterior lens luxation, aniridia, and anisometropia, treated with colored soft contact lens.

Posterior lens luxation without sight threatening complication can be managed conservatively. However, vitrectomy and lensectomy surgery on posterior lens luxation needs to be considered if there are complications or if the patient requires other ocular surgery. Aniridia can be acquired through ocular trauma, with treatment options ranging from colored contact lens, corneal tattoo, iris sutures, and implantable iris prosthesis. In this case, the management of aphakic condition caused by posterior lens luxation combined with aniridia includes the consideration of conservative through aphakic contact lens, or surgery of vitrectomy, lensectomy, IOL and iris prosthesis implantation.

Combined condition of post-traumatic aphakia and aniridia is a challenging situation which required many considerations.