gms | German Medical Science

Aim: A fifty-nine-year-old patient underwent blunt trauma involving wood while working with a saw on 27^th May 2022. Ten years earlier, he had been struck and suffered a nasal bone fracture. On admission on 8^th June 2022, he presented with a BCDVA of 0.01 and an IOP of 10 mmHg. Slit-lamp examination revealed a subluxated post-traumatic cataract disabling fundoscopy, iris damage and atonic, wide, irregular pupil. Ultrasound examination revealed vitreous hemorrhage and choroidal detachment.

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Methods: On 8^th June 2022, the following procedures were performed. A 23-gauge pars plana vitrectomy, lensectomy with 20-gauge vitrector, four-flanged intrascleral intraocular lens (IOL) fixation as by Canabrava et al. and single-pass four-throw pupilloplasty according to Agarwal et al, followed by posterior vitreous detachment, endolaser and silicone oil tamponade. Consecutive steps of this combined procedure are presented on a film. On 14th September 2022 another 23-gauge vitrectomy with silicone oil removal was performed.

Results: Follow-ups within the timespan of three months between two vitrectomies showed stable BCDVA 0.7 and IOP results within normal limits under anti-glaucoma monotehrapy with normal macular anatomy shown on optical coherence tomography (OCT). After the second intervention, on 22^th September 2022, UCDVA 0.7, IOP 17 mmHg, on autorefractometry +0.25 Dsph/-0.5 Dcyl ax78. OCT showed normal macular thickness and profile.

Conclusions: In the presented case, anterior segment surgical management with four-flanged intrascleral IOL fixation and single-pass four-throw pupilloplasty proved suitable as an iro=is-lens diaphragm during the perfomance of vitrectomy with silicone oil tamponade. Furthermore, the follow-up period until second vitrectomy was uncomplicated. Six month follow-up after second vitrectomy with silicone oil removal showed stable BCDVA, IOP and anatomical results. Longer-term results are awaited.