The pathognomic sign of the condition - tearing of the peripheral portion of the iris root from the ciliary spur - appears as a black slit at the limbus.7

5 Ethicon/Johnson & Johnson, New Brunswick, N.J. Every suture mentioned in this chapter is one of the two types described above.

6 Monocular diplopia, photophobia.

7 It is usually visible to the naked eye, although the slit lamp is often needed to confirm the diagnosis. If the iridodialysis is large enough, a red reflex is apparent where it should not be (Fig. 2.7.2).

An iridodialysis also deforms the shape of the pupil. Angle recession and glaucoma are common associated pathologies.

Surgical reconstruction is recommended if the condition causes visual disturbance (monocular diplopia, glare, photophobia). The treatment concept is based on the McCannel suture [8]. A double-armed suture is used in either of the two techniques (Fig. 2.6.4). Acute Traumatic Aniridia: "the Case of the Missing Iris"

It is not uncommon to find the iris completely extruded in severe ruptures. It is also possible that the iris is not actually lost, it is just rolled up and pulled posteriorly by fibrin initially and scar tissue subsequently ("pseu-doaniridia"). The earlier such an iris retraction is discovered, the easier its unrolling is. If done before scar tissue develops, careful pulling on the iris at the pupillary margin with vitrectomy forceps introduced through a paracentesis is often able to reestablish the iris diaphragm. Pulling of the iris back to its normal position is not without risk.

• If scarring has already started, the iris can be torn from its root.

• If the pulling is too forceful, severe bleeding may occur.

• If the forceps holding the iris is squeezed too strongly, the pupillary margin can be seriously damaged.

Sutures may be necessary to maintain the recreated smaller pupil (see above).

A Controversial

It is not always possible to explain how the iris can disappear after a severe rupture. Often there is no sign of iris extrusion, nor is the iris found during surgery. One must presume an acute dissolution of the tissue, although it is difficult to comprehend how this can occur so instantly.

For true traumatic aniridia, some type of correction is advised because of the associated photophobia and/or cosmesis. The options range from the simple to the complex (Fig. 2.6.5; Table 2.6.2), including prostheses that also have built-in refractory correction (IOL).

15 mm

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