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Fibrin membrane pupillary-block glaucoma is an uncommon complication after phacoemulsification cataract surgery. We present a case treated successfully by pharmacological dilation of the pupil. Previous case reports have recommended the use of Nd:YAG peripheral iridotomy, Nd:YAG membranotomy and intracameral tissue plasminogen activator.The patient presented with intraocular pressure (IOP) of 45 mmHg 2 days after uneventful phacoemulsification cataract surgery. Anterior segment optical coherence tomography revealed that a fibrinous membrane-filled space had formed between the pupillary plane and the implanted intraocular lens.The diagnosis of fibrin membrane pupillary-block glaucoma was made. Initial treatment consisted of IOP-lowering medication and topical pupillary dilation (atropine 1%, phenylephrine hydrochloride 10% and tropicamide 1%). Within 30 min, the dilation broke the pupillary block and the IOP was 15 mmHg. The inflammation was treated with topical dexamethasone, nepafenac and tobramycin. Within a month, the patient reached a visual acuity of 1.0., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Reverse sulcus intraocular lens (IOL) implantation can cause serious ophthalmic complications. Even routine ocular examinations can provoke significant consequences. Herein, we present a case of recurrent pupillary capture and pseudophakic pupillary block related to reverse sulcus IOL implantation., Case Report: A 44-year-old man developed a pseudophakic pupillary block after pupil dilation aimed at relieving pupillary capture in an undetected reverse position of the sulcus IOL. The pupillary block was successfully treated with 2% pilocarpine and laser peripheral iridotomywas performed to prevent recurrence. The patient experienced recurrent pupillary capture with decreased vision in the affected eye. IOL exchange was the definite treatment resulting in improved vision and proper positioning of the IOL., Conclusions and Importance: When the reverse position of sulcus IOL is detected postoperatively, prophylactic laser peripheral iridotomy should be considered to prevent pupillary block particularly when pupillary capture is present. Pharmacologic pupillary dilation should be performed cautiously. Recurrent pupillary capture is possible and IOL repositioning should be considered to prevent further complications., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Purpose: To compare 6 methods for intraoperative pupil dilatation in eyes with insufficient pupil size during phacoemulsification., Methods: This was a prospective case-control study. 99 microcoria cataract patients (120 eyes) were collected and were divided into 6 groups(20 eyes each group), and their pupils were dilated by bimanual stretching pupil (group I), pupil radial cut open(group II), mechanical pupil dilatation with iris-retractor hooks (group III), OASIS iris expander (group IV), and Malyguin-ring (Microsurgical company, America) (group V), B-HEX Pupil Expander (Med Invent Devics, India)(group VI),respectively. 3.0 mm clear corneal incision were used in phacoemulsification. All cases were followed up at 1 week and 1, 3, 6 months after the surgery. The best corrected visual acuity (BCVA), intraocular pressure(IOP), corneal endothelium cell density(ECD), pupil diameter(PD) of before and after surgery were compared., Results: One same doctor finished all cataract surgeries successfully. The eyes' condition before surgery and at 6 months after surgery were compared. There were no significant statistical differences for the conditions of the eyes before surgery among six groups. The ECDs were better at 6 months postoperatively in group III and V, median values: 2114/mm 2 , 1961/mm 2 . PD was largest in group II (median value: 5.5 mm), which was significantly larger than other groups (P adjusted  < 0.05)., Conclusions: All 6 methods used in this study were effective for the mechanical dilatation of small pupils and didn't affect the postoperative visual acuity and intraocular pressure in microcoria cataract phacoemulsification. Iris-retractor hooks and the Malyugin Ring can reduce intraoperative corneal endothelium cell loss. Postoperative PD is larger when the iris was cut open radially., (© 2022. The Author(s).)

Abstract: A 42-year-old Algerian man presented for binocular oblique diplopia, hypersomnolence with drop attacks, bilateral hearing loss, and thoracic pain. He had a right thalamomesencephalic hemorrhage due to an underlying cavernous malformation treated with subtotal surgical resection. On neuro-ophthalmic examination, the patient had a left relative afferent pupillary defect and a right oculosympathetic efferent pupillary defect (i.e., Horner syndrome) in addition to other thalamomesencephalic eye and neurologic signs (right fourth nerve palsy, hearing loss, hemiparesis, and thalamic pain). Clinicians should recognize the localizing value of this unique constellation of mesencephalic afferent and efferent pupillary defects., Competing Interests: The authors report no conflicts of interest., (Copyright © 2020 by North American Neuro-Ophthalmology Society.)

Competing Interests: Competing interests: None declared.

A 7-year-old girl presented with watering and redness in the left eye for 2 months. Her parents reported poor vision in both eyes for 4 years. Visual acuity was finger counting at 1 m and finger counting close to face in the right and left eyes, respectively. Slit lamp examination of the right eye revealed corectopia, aphakia in the pupillary area, temporally subluxated clear crystalline lens, persistent pupillary membrane, irido-hyaloidal adhesion and poorly dilating pupil. Left eye revealed central corneal oedema with descemet scarring, anteriorly dislocated clear crystalline lens with lenticulo-corneal touch. Ultrasound examination of the left eye was normal. Hence a diagnosis of ectopia lentis et pupillae with left eye spontaneous anterior dislocation of the lens along with corneal decompensation was made. The child underwent microscope integrated intraoperative optical coherence tomography guided intralenticular lens aspiration with optical iridectomy in the left eye. Postoperative visual rehabilitation was done with aphakic glasses., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: To describe a technique of surgical peripheral iridectomy via a clear-cornea tunnel incision to prevent or treat pupillary block following phacoemulsification., Methods: Description of technique and retrospective description results in 20 eyes of 20 patients with acute angle closure with coexisting visually significant cataract undergoing phacoemulsification considered at risk of postoperative papillary block as well as two pseudo-phakic eyes with acute postoperative pupillary-block. Following phacoemulsification and insertion of an intraocular lens, a needle with a bent tip was inserted behind the iris through the corneal tunnel incision. A blunt iris repositor was introduced through the paracentesis and placed above the iris to exert posterior pressure and create a puncture. The size of the puncture was enlarged using scissors. For postoperative pupillary block the same technique was carried out through the existing incisions created for phacoemulsification., Results: Peripheral iridectomy was successfully created in all 22 eyes. At a mean follow-up of 18.77 ± 9.72 months, none of the iridectomies closed or required enlargement. Two eyes had mild intraoperative bleeding and one eye a small Descemet's detachment that did not require intervention. No clinically significant complications were observed. Visual acuity and IOP improved or was maintained in all patients. The incidence of pupillary block in our hospital was 0.09% overall, 0.6% in diabetics and 3.5% in those with diabetic retinopathy., Conclusions: This technique of peripheral iridectomy via the cornea tunnel incision can be safely used during phacoemulsification in eyes at high risk of pupillary block or in the treatment of acute postoperative pupillary-block after cataract surgery. The technique is likely to be especially useful in brown iris, or if a laser is not available.

A 20-year-old woman, a registered nurse, presented with best-corrected visual acuity of 6/15 (20/50) due to bilateral extensive persistent pupillary membrane. Sequential argon laser photocoagulation of the iris strands at the pupillary membrane iris collarette followed by neodymium:YAG laser lysis resulted in partial clearing of the central visual axis without bleeding. Best-corrected visual acuity improved to 6/9 (20/30) bilaterally without complications noted 1 year after combined laser therapy., (2015 BMJ Publishing Group Ltd.)

Frequently, in literature and curent practice, accessory iris membrane (AIM) and persistant pupillary membrane (PPM) are confused. Both AIM and PPM are congenital iris anomalies in which fine or thick iris strands arrise form the collarette and obscure the pupil. AIM, which is also called iris duplication, closely resembles the normal iris tissue in color and thickness and presents a virtual second pseudopupil aperture in the centre while PPM even in its extreme forms presents as a translucent or opaque membranous structure that extends across the pupil and has no pseudopupil. Mydriatiscs, laser treatment or surgery is used to clear the visual axis and optimize visual development. Surgical intervention is reserved for large, dense AIMs and PPMs. Our patient, a 29 year old male, has come with bilateral dense AIM, bilateral compound hyperopic astigmatism, BCVA OD = 0.6, BCVA OS = 0.4, IOP OU = 17 mmHg. To improve the visual acuity of the patient we decided to do a bilateral membranectomy, restoring in this way transparency of the visual axis. After surgery, the visual acuity improved to BCVA OD= 0.8, BCVA OS=0.8.

Aim: To investigate the effects of emergency burr hole drainage for acute subdural hematoma (ASDH) with bilateral non-reactive pupils., Material and Methods: A retrospective study was conducted by reviewing medical records from 1998 to 2007. Patients meeting the following criteria were included: 1) head injury with unconsciousness (Glasgow Coma Scale score 8); 2) bilateral non-reactive pupils on arrival; 3) ASDH with disappearance of basal cistern on computed tomography (CT); and 4) performance of emergency single burr hole drainage. Subjects were divided into survival and non-survival groups., Results: Pupil size on the small side was significantly smaller in the survival group than in the non-survival group. All pupils on the small side in the survival group were 4 mm., Conclusion: Emergency burr hole drainage should still be considered in patients with ASDH showing bilateral non-reactive pupils and one pupil 4 mm.

Purpose: To determine safety, clinical and visual results, and potential complications of early radial optic neurotomy (RON) surgery in eyes with central retinal vein occlusion (CRVO), with relative afferent pupillary defect and visual acuity, Materials and Methods: This prospective, interventional case-series included 24 patients of CRVO who underwent RON within 2 months of disease onset. The preoperative examination included slitlamp biomicroscopy, fundus photography and fluorescein angiography. Foveal thickness was measured using optical coherence tomography (OCT) in the last 6 eyes only. In each case, RON was performed after informed consent. Two radial incisions were placed in the nasal quadrant of the optic disc, using a micro-vitreoretinal blade. The postoperative change in vision, clinical picture, fundus photographs, angiograms and foveal thickness by OCT were the main outcome variables studied. The Wilcoxan signed test was used to assess the results., Results: Average symptom duration was 37.8 +/- 15.2 days (range 15-60 days, median: 34.5 days) and follow-up 7.7 +/- 2.1 months (range 1-12 months, median: 8 months). Visual outcome: 2 (8.33%) eyes each had fall and preservation of pre-RON visual acuity respectively. Twenty eyes (83.33%) showed increase in vision (of average 3 lines). Pre and postoperative vision ranged from 0.017-0.1 (average:0.061) and 0.017-0.667 (average: 0.17) respectively (P < 0.05). Clinical and angiographic outcome: decline in macular oedema, decreased or resolved intraretinal haemorrhages, resolution of venous dilatation and disc oedema could be appreciated in all cases. Foveal thickness: average pre and postoperative foveal thickness was 834.17 microm and 556.17 microm respectively (P < 0.05) in the 6 eyes where it was measured before and after RON. One eye developed retinal-detachment., Conclusion: Radial optic neurotomy is better than the natural course in eyes with CRVO, with vision < 6/60.

Background: To evaluate the visual outcome following cataract surgery with pupillary sphincterotomy in eyes with coexisting corneal opacity., Methods: Patients with leucomatous corneal opacity with significant cataract were enrolled for the study. The uncorrected visual acuity and best-corrected visual acuity (BCVA) were recorded and the anterior segment was thoroughly evaluated by a slit lamp biomicroscope before the surgery. Only those patients who had some amount of clear peripheral cornea were selected. Posterior segment pathology was ruled out by indirect ophthalmoscopy after pupillary dilatation, if possible, or by B-scan ultrasonography. Conventional extracapsular cataract extraction with pupillary sphincterotomy was performed and an intraocular lens was implanted. Postoperatively, the eyes were evaluated on day 1, and 1 week and 6 weeks following surgery for similar parameters., Results: Fourteen eyes of 14 patients were included in the study, of which 13 (92.85%) patients were male. The mean age of the patients was 47.85 +/- 7.37 years. All the eyes had a dense central leucomatous corneal opacity. Twelve (85.71%) eyes had two or more quadrants of deep vascularisation. Sphincterotomy was performed mostly (71.42%) in the nasal or inferonasal quadrant. The intraocular lens was implanted in 13 (92.85%) eyes, and one (7.1%) eye was left aphakic due to the occurrence of a large posterior capsular tear. Preoperatively, all eyes had BCVA < 6/60. At 6 weeks after surgery, all eyes had BCVA >or= 6/60 and four (28.57%) eyes had BCVA >or= 6/18. The mean BCVA preoperatively in these eyes was 0.015 +/- 0.009, which changed to 0.249 +/- 0.102 at 6 weeks following surgery., Conclusions: Extracapsular cataract extraction and intraocular lens implantation with pupillary sphincterotomy provides ambulatory and useful vision to patients of cataract with coexisting central leucomatous corneal opacity.

Background: Pupillary block rarely occurs after cataract extraction with posterior chamber intraocular lens implantation., Methods: A series of six patients (seven eyes) treated for pupillary block after posterior chamber intraocular lens implantation between 1990 and 2001 is described; in one eye, the attack occurred after phacoemulsification., Results: The interval between pupillary block development and the cataract surgery ranged from 1 day to 5 years. In all eyes, treatment consisted of neodymium-YAG laser peripheral iridotomy. In four eyes, the laser peripheral iridotomy relieved the block (one procedure in two; two to three procedures in two). One patient was also treated with YAG capsulotomy, and two patients needed additional surgical intervention., Conclusion: Despite the rarity of the complication of pupillary block after posterior chamber intraocular lens implantation, physicians should be aware of the sometimes difficult course of recovery after treatment.

Background: In 1986 Cibis and associates described 2 children with a new type of congenital pupillary-iris-lens membrane with goniodysgenesis that was unilateral, sporadic, and progressive. These membranes were different from the common congenital pupillary strands that extend from 1 portion of the iris collarette to another or from the iris collarette to a focal opacity on the anterior lens surface. They also differed from the stationary congenital hypertrophic pupillary membranes that partially occlude the pupil, originating from multiple sites on the iris collarette, but not attaching directly to the lens., Case Material: The present report is an account of 7 additional infants with congenital iris membranes, similar to those reported by Cibis and associates, which caused pupillary distortion and were variably associated with adhesions to the lens, goniodysgenesis, and progressive occlusion or seclusion of the pupil. Six of the 7 patients required surgery to open their pupils for visual purposes or to abort angle closure glaucoma. A remarkable finding was that the lenses in the area of the newly created pupils were clear, allowing an unobstructed view of normal fundi., Conclusion: This type of fibrous congenital iris membrane is important to recognize because of its impact on vision and its tendency to progress toward pupillary occlusion. Timely surgical intervention can abort this progressive course and allow vision to be preserved.