Ophthalmology Dx: An Unlucky Streak

Slideshow

  • Figure 1. This slit lamp image shows the patient's right eye one day after cataract removal. Can you identify the cause of his visual disturbance?

  • Figure 2. This closer view shows the patient's right eye (disregard the rectangular photo defect in the center). What can this image tell you about the patient's likely diagnosis?

A 79-year-old male patient presented to the clinic for a 1-day follow-up appointment after undergoing cataract surgery for his right eye. His best-corrected visual acuity was 20/20. His drug history was notable for tamsulosin prescribed for benign prostatic hyperplasia. During surgery, the patient sustained damage to the temporal iris. He then reported experiencing photophobia in sunlight and a “very annoying” streak of light across his central vision at night when looking at any bright light source.

During surgery, alpha 1 adrenoreceptor antagonists, such as tamsulosin, can inhibit pupil dilation, causing the iris to become floppy.1 With this condition, intraoperative floppy iris syndrome (IFIS), the iris may become aspirated and injured by the tip of the phaco...

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During surgery, alpha 1 adrenoreceptor antagonists, such as tamsulosin, can inhibit pupil dilation, causing the iris to become floppy.1 With this condition, intraoperative floppy iris syndrome (IFIS), the iris may become aspirated and injured by the tip of the phaco probe during surgery. It can also lead to prolapse of the iris through the incision, resulting in potential lasting damage. However, while present, the IFIS itself is not the cause of the patient’s visual phenomena. 

The intraocular lens insertion process can cause wrinkles in the posterior capsule for any patient, regardless of their medication history. Postoperative posterior capsule wrinkles may occur as a result of traction between the intraocular lens and the posterior capsule. In this patient’s case, the light streak resolved without intervention in 8 days. If the condition does not resolve on its own, YAG capsulotomy can be applied to eliminate the wrinkle.2

Matthew Garston, OD, is an adjunct professor at the New England College of Optometry and a senior staff optometrist in the medical department at MIT.

References

1. Handzel D, Briesen S, RauschS, Kälble T. Cataract surgery in patients taking alpha-1 antagonists know the risks, avoid the complications. Dtsch Arztebl Int. 2012;109(21):379-84. doi:10.3238/arztebl.2012.0379.

2. Nagata M, Matsushima H, Senoo T. Posterior capsule wrinkle after cataract surgery. Poster presented at the European Society of Cataract and Refractive Surgeons Congress, London, England, 2014.

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