A corneal perforation with prolapsed iris!!!
Prolapse of the iris is frequently encountered following trauma, during cataract surgery (referred to as intraoperative floppy iris syndrome), through a perforated corneal ulcer, or through a corneal melt.Depending on the duration of prolapse, the appearance of the iris may vary.In peripheral iris prolapse, the iris appears as a knuckle of colored tissue, resulting in a partial peripheral synechia. When the prolapse is central, the entire pupillary margin may prolapse, resulting in a total anterior synechia.Prompt surgical management is necessary when conjunctival coverage is not present or in the presence of complications. The primary goal of surgery is to restore the anatomical integrity of the eye with visual restoration being only a secondary goal.The iris should be either repositioned or excised. Reposition is achieved when acetylcholine is instilled through a paracentesis incision into the anterior chamber, which constricts the pupil and may release the iris incarceration. If the iris does not appear viable, then it is excised. The iris should be excised if signs of epithelialization are present. To excise, the prolapsed iris is cut flush with the corneal surface. Then the iris defect may be closed using a polypropylene suture on a vascular needle.