Implantation Of A Black Diaphragm Intraocular Lens For Traumatic Aniridia In Eyes With Prior Pars Plana Vitrectomy

Purpose: To evaluate the efficacy of secondary black diaphragm intraocular lens (IOL) implantation in aphakic eyes with traumatic aniridia and previous pars plana vitrectomy (PPV).Metbods:This retrospective study comprised 15 aphakic eyes with aniridia and no vitreous that had implantation of a secondary black diaphragm IOL 6 to 72 months after PPV. The PPV was performed as a result of trauma to the posterior segment. Before implantation of the IOL, all patients had reduced visual acuity from aphakia and intolerable glare from aniridia. Eyes were aphakic as a result of previous extracapsular cataract extraction (1 eye), lens extrusion during trauma (3 eyes) or simultaneous cataract lensectomy during PPV (11 eyes). Significant iris defects were present, with 9 eyes being aniridic after the injury. The mean follow-up was 17 months (range 3 to 34 months). The postoperative visual acuity, intraocular pressure (IOP), endothelial cell density, IOL centration and intraocular inflammation were monitored. Results: All 15 eyes had improved visual acuity and marked glare reduction after IOL implantation. No major IOL decentration was seen. 5 patients had increased intraocular pressure three to five days after IOL implantation, 3 were known to have secondary glaucoma from trauma before surgery and their IOP was controlled preoperatively (< 21 mmHg) with timolol 0.5% eyedrops. The other 2 patients had normal appearing angles, and 1 was diagnosed as hemolytic glaucoma after IOL insertion. Postoperative elevated IOP was controlled by timolol eyedrops (4 eyes) or selective laser trabeculoplasty (1 eye). Hyphema was seen in 1 patient on the first day after IOL implantation, but no further bleeding was noted. Vitreous hemorrhage was seen the first day after IOL insertion in 2 patients. One resolved without sequelae, the other required vitreous washout. Retinal detachment and cystoid macular edema was not seen in any patient.Conclusions: Black diaphragm IOL implantation can be considered in patients with coexisting aphakia and aniridia and without vitreous. Intraoperative IOP regulation is crucial in vitrectomized eyes to prevent complications such as expulsive hemorrhage. In general, visual function was better after IOL insertion as a result of better visual acuity and glare reduction. Although this IOL appears to be safe, long-term results must be assessed in studies with a longer follow up and larger study group.