Pupillary Capture Technique
I read the case report by Gayton and coauthors1 regarding pupillary capture in secondary piggyback implantation, and I want to share my experience with the treatment of pupillary capture.
We have seen a sharp decrease in pupillary capture from the times of extracapsular cataract extraction, intraocular lenses (IOLs) without angulation, IOLs placed in the ciliary sulcus, and no Miochol® (acetylcholine chloride) or Miostat® (carbachol) easily accessible (at least in our country in the early 1980s). At that time, we published a case report2 of a patient with pupillary capture who was treated with “corneal indentation with a Posner gonioscopy 4-mirror lens.” The lens has a radius of curvature of 7.7 mm, which permits it to come into direct contact with the anterior corneal surface with no fluid-filled chamber between the cornea and the lens. This type of lens, based on the Zeiss 4-mirror contact goniolens, has been useful for gonioscopy with corneal indentation to distinguish between appositional angle closure and synechial closure.
In our case, the pupillary capture resolved by dilating the pupil with a short-acting cycloplegic agent, performing corneal indentation until the displaced edge of the IOL returned to the posterior chamber, and applying a miotic. We treated a second patient with pupillary capture with corneal indentation with the same good results. The advantage of this technique is that it is noninvasive and does not require inserting a needle into the anterior chamber to press back the optic.
Miguel Paciuc MD
aMexico City, Mexico
1. Gayton JL, Sanders V, Van Der Karr M. Pupillary capture of the optic in secondary piggyback implantation. J Cataract Refract Surg 2001; 27:1514-1515
© 2002 by Lippincott Williams & Wilkins, Inc.
2. Paciuc M, Villar J, Diaz MA, Gil F. Corneal indentation in the management of pupillary capture. Cataract 1985; 2:32-33