EW CATARACT
34
August 2017
Figures 4 and 5: The patient in the second case has iris incarcerated in the superior wound, and there is a bridge of capsule supporting the IOL superiorly with vitreous poking around the edge
of the lens into AC. These images show the eye prior to dilation.
sufficiently covered. If a superior
pupilloplasty is used and the pupil
is displaced too superiorly, either an
inferior sphincterotomy or, more re-
cently, a technique using intraocular
cautery to move the pupil inferiorly
and expand it as required may be
employed."
What was done
First a pars plana vitrectomy was
carried out to eliminate the vitreous
from the anterior segment for an
unencumbered repair of the iris. It
was determined by inspection that
the current IOL was stable, centered,
and not damaged, so the lens was
left alone. The superior iris was care-
fully dissected out of the wound as
much as possible using a bimanual
approach, pulling on the iris with
a microforceps (23 g micrograsper,
MST, Redmond, Washington) in one
hand while the second hand used a
27 g needle alternating with an MST
microscissor to carefully free up as
much of the iris as possible. Then
the defect was closed with multiple
interrupted 10-0 Prolene sutures.
During the closure a relaxing inci-
sion in the superior iris was created
at 10 o'clock to allow the pupil to
be centered and to cover the IOL
edge superiorly. There was no need
to cut or cauterize the iris at 6
o'clock to center the pupil in this
case. The patient's glare problems
completely resolved, and her best
corrected vision improved by two
lines. It should be noted that large
Eye continued from page 33
Figures 6 and 7: Day 1 after pars plana vitrectomy and iris repair
Source (all): Steven Safran, MD
limbal relaxing incisions were also
placed at 3 and 9 o'clock to treat her
against-the-rule astigmatism, which
was reduced from more than 3 D to
less than 1 D. Her uncorrected vision
improved even more significantly,
which the patient was very happy
about as well.
These cases demonstrate the
plasticity of the iris and how this
can be used to the advantage of the
surgeon to address problems that
may be long-standing but a per-
sistent problem to the patient. Iris
abnormalities may create cosmetic
and functional problems that can
often be significantly improved
with creative surgical interventions.
While it is not always possible to
completely restore the anatomy to
normal, these patients can be im-
proved functionally by centering the
pupil and eliminating edge glare. EW
Editors' note: Dr. Snyder has financial
interests with HumanOptics (Erlangen,
Germany). The other physicians have
no financial interests related to their
comments.
Contact information
Asbell: penny.asbell@mssm.edu
Goren: matthewgoren@yahoo.com
Groos: egroos@gmail.com
Hoffman: rshoffman@finemd.com
McKee: mckee@swhec.org
Safran: safran12@comcast.net
Snyder: msnyder@cincinnatieye.com
Teichman: josh.teichman@gmail.com
Wilbanks: gawilbanks@mac.com
