Cataract surgical problem
Consultation – Feb # 6
In examining the photograph of this interesting case, it appears as though the inferior area of pupillary capture shows that the edge of the optic is more elevated from the iris than the superior portion. It would be important to know what the iris looks like on transillumination. Is there evidence that the optic of the lens in this area of capture had previously been rubbing against the posterior surface of the iris, causing pigment loss and possibly chronic irritation or inflammation of the eye? If there does not appear to be a history or evidence of chronic trauma and irritation, my recommendation would be to merely reposition the iris. However, if there is evidence of significant chronic inflammation in the eye from the optic rubbing against the posterior surface of the iris, the IOL may have to be removed at some point even though the haptics appear to be significantly scarred to the ocular tissues.
To reposition the iris, I would make a small stab incision and use a cyclodialysis spatula to bring the iris anterior to the optic where it has been captured. After this, the patient could be treated with brimonidine tartrate (Alphagan) or weak-strength pilocarpine to keep the pupil small and minimize the risk for future pupillary capture. A peripheral iridectomy might help as well.© 2005 by Lippincott Williams & Wilkins, Inc.