A Mirror of Hospital Practice

CASE OF TRAUMATIC IRIDODIA-

LYSIS TREATED BY OPERATION

By E. J. SOMERSET CAPTAIN, I.M.S.

P'ofcssor of Ophthalmology, Medical College, Calcutta

The opportunity of operating upon a case 01

extensive iridodialysis rarely presents itself and ^ is therefore thought that a report 011 a case

may be of interest. The iridodialysis in most cases is too small to require surgical repair but a larger one may give rise to diplopia and

diminished vision. The operation may also be performed for cosmetic reasons.

Spaeth (1939) describes the operation and various modifications by Key (1932), Jameson (1909), and Wheeler (1934).

Case report P. R., age 34, male, while repairing a tele-

phone pole, was suddenly struck in the left eye by one of the wire supports. The wire had a

diameter of about ^ inch and it was the side of the wire, not the sharp end which struck him. He was treated in the local hospital and about three weeks later was admitted to the Eye Infirmary, Medical College Hospital, Calcutta. On examination.?Left vision =6/24. There

was no congestion and the eye was quiet. Cornea normal. Anterior chamber deep. The

pupil was irregular but there were no synechia or K.P. A large iridodialysis from 1 o'clock to 5 o'clock was seen (see figure 1). Some

traumatic lens opacity was apparent. Tension was normal. Vitreous and retina appeared normal.

Right eye vision = 6/6 normal. Operation.?On 18th March, 1945, the eye

was cocainized and the upper division of the

facial nerve was infiltrated with novocaine 2

per cent. A small conjunctival flap was dissected

up from 2 to 4 o'clock (see figure 2). A keratome incision was made at 3 o'clock in the

sclera about 1.5 mm. from the apparent limbus (see figure 3). Iris forceps were introduced and the lower half of the peripheral border of the

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7G THE INDIAN MEDICAL GAZETTE [Feb., 1947

iris dialysis was grasped and gently pulled into the lips of the wound (see figure 4). The upper half of the peripheral border of the dialysis was

then treated in a similar manner. This resulted in the complete reposition of the iris except for a very small ' button hole ' at 1 o'clock (see

figure 5) which was left as complete reposition would have necessitated extension of the incision

upwards. The iris was drawn into the wound

so that its edge was included in the lips of the wound but not so far as to prolapse through the wound. The conjunctival flap was sutured with

one stitch and one drop of guttse atropine sul-

phate 1 per cent instilled.

Progress was uneventful; the eye healed rapidly and was white in 8 days. The tension remained normal. Subsequently the pupil was seen to be slightly dilated and only reacted to light on the nasal side. Vision improved to

6/18.

Comment

The operation proved to be very easy and no reaction was observed. No iris stitch was found to be necessary, the edge of the iris adher- ing between the lips of the keratome incision most satisfactorily. It would seem that stitch- ing the iris to the sclera is not desirable as the risk of iritis would be much greater.

Summary A case of traumatic iridodialysis and its

operative repair is described.

REFERENCES

Jameson (1909) .. Arch. Ophthalmol., p. 38.

Key, B. W. (1932) .. Ibid., 7, 748.

Spaeth, E. B. (1939) .. The Principles and Practice of Ophthalmic Surgery. Lea and Febiger, Phila- delphia.

Wheeler, J. M. (1934). Amer. J. Ophthalmol., 17, 683.

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