Faculty Bibliography

PURPOSE: The aim of this study is to report the clinical features, imaging studies, surgical removal, and pathology of congenital iris flocculi in a patient who developed a life-threatening dissecting aortic aneurysm after 55 years of follow-up. METHODS: Documentation with iris photography was performed from age 18 to 55 years, at which time anterior segment optical coherence tomography (OCT) was performed. At the time of subsequent cataract surgery, the iris flocculi were removed in each eye and submitted for light and electron microscopy. RESULTS: The size and shape of the iris flocculi waxed and waned over the years but caused no visual disturbance. Anterior segment OCT demonstrated clear, round cysts with thin lining and no solid component. At the age of 55, congestive heart failure from a dissecting aortic aneurysm was discovered and surgically repaired. Subsequent bilateral cataract surgery and cyst removal were performed, and the iris flocculi were studied with light and electron microscopy. CONCLUSIONS: Congenital iris flocculi cause little, if any, visual impairment in most cases. However, they are occasionally associated with dissecting aortic aneurysm due to a shared mutation in smooth muscle that affects both the iris and the aorta. Patients with iris flocculi should be monitored periodically for aortic abnormalities.

To test the theory that removing lens epithelial cells at the time of cataract extraction with intraocular lens (IOL) implantation or refractive lens exchange might decrease the rate at which the anterior capsule becomes adherent to the lens optic postoperatively, we performed the technique in approximately 200 eyes that were considered likely to require postoperative IOL exchange. In 4 eyes that had an IOL exchange procedure 6 to 12 weeks after the primary procedure, the anterior capsule was nonadherent or weakly adherent to the lens optic