Eyelids & the Anterior Segment:
                    Case seventeen

The above picture shows the left eye of a 60 year-old man who had had a right phacoemulsification and implant two weeks earlier.

a. What is the diagnosis?

Pupillary capture.
It occurs when a part of the optic moves anterior to the iris. Its incidence is increased in:
  • pupillary dilatation during the early postoperative period
  • use of lenses with non-angulated haptics

b. What complications can arise?

In the majority of patients, complications do not occur.
The possible complications are:
  • cosmetic defect with eclliptical shaped pupil especially in patients with light iris
  • astigmatism if the lens were significantly decentred
  • low grade inflammation with uveitis and possibly cystoid macular oedema
  • pupillary block glaucoma rarely occur

c. What are the treatment options?

Treatment may not be needed if the patients were asymptomatic. Repositioning of the lens can be achieved with:
  • medical treatment. This may be achieved with intense dilatation with the patient in a supine position. When the lens falls back, the pupil is constricted. This needs to be done in the early post-operative stage before posterior synechiae occurs between the iris and the posterior capsule
  • surgical repositioning (which was performed in this patient)
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