1. Traumatic Aniridia During Extracapsular Cataract Surgery
Singapore National Eye Centre
Traumatic Aniridia During Extracapsular Cataract Surgery
Karen Chia, MD
Lavanya Raghavan, MD
Zainah Alsagoff, MD
*There are no financial relationships to disclose.

2. Introduction
Extra-capsular cataract extraction is important for the resident to learn well as it is used for
advanced cataracts or
in patients with multiple eye conditions where phacoemulsification is not suitable.
It may also be necessary to convert a case of phacoemulsification to ECCE at times when complications occur.

3. It is important thus to know complications of ECCE.
Here we describe two rare cases of total aniridia during ECCE

4. Case 1
A 85 year old female underwent cataract surgery by a resident under consultant supervision.
Pre-operative best corrected visual acuity (BCVA) was 6/45. Cataract was nuclear sclerosis 4+. Pupil was small and there was difficulty in dilation. ECCE was performed and during nucleus expression there was expulsion of the iris during nucleus delivery.
Infusion-aspiration was continued and eventually a standard IOL was inserted into the bag.

5. Her BCVA was 6/24. She had no complaints of glare
Her BCVA was 6/24. She had no complaints of glare. Intra-ocular pressure remained within normal with no retinal complications. Tinted glasses were advised.
A phacoemulsification done for her other eye a couple of months later and the surgeon noted a “floppy iris”.

6. Post Operative Images

7. Case 2
59 year old male with history of benign prostatic hypertrophy, on terazosin, underwent ECCE.
Pre-operative BCVA was 6/12. Cataract was nuclear sclerosis 3+. Similarly there was iris expulsion with the nucleus delivery.

8. BCVA was 6/6. He was a driver and had photophobia and was bothered by the glare. Initially he tried colored contact lens but he was unable to tolerate it. Six months later, he underwent Morcher ring implantation. He developed glaucoma, which required treatment with 2 eyedrops.

9. Post Operative Images

10. Discussion
It is extremely uncommon for total aniridia to occur during ECCE. Various reasons for their occurrence are as follows:
In case 1, the resident may have accidentally tugged on the iris with the calibri.
In case 2, there may have been excessive pressure applied on the inferior limbus during nucleus expression.

11. Another possibility is whether or not both patients may have some form of intraoperative floppy iris syndrome (IFIS)
In case 1, she had a small pupil intraoperatively and the iris in her other eye was found to be floppy during phacoemulsification
In case 2, the patient was on terazosin. There is only one case report so far of IFIS with terazosin.

12. Prevention
Surgeons have to take extra care during surgery, especially during nucleus expression
A good history must be taken to highlight cases possible IFIS
In cases of possible IFIS, iris hooks or intracameral epinephrine may be useful.
Managing the complications is important as well.