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Iris defects and distorted pupils are commonly managed with iris suturing techniques that aim to close the defect and/or reform the physiological pupil. The re-creation of an optimally sized and centered pupil is often challenging because of missing iris, asymmetrical iris damage, or variable tension around the pupil. Current options include removing or cutting iris tissue using microscissors or the vitreous cutter, instrument stretching, or postoperative laser photocoagulation. Iris microendodiathermy is a simple technique that is minimally traumatic, titratable, and controlled, avoids excessive tissue manipulation, and is able to create a round cosmetically pleasing pupil. A bipolar endodiathermy cautery is applied to the iris stroma to induce tissue contraction and to gently pull the pupil in the meridian to which probe is applied. Endothermal pupilloplasty (EDP) may be used to recenter or enlarge a small pupil, thereby avoiding additional trauma inflicted by a vitrector or microscissors that physically cuts the iris.

Cyclodialysis causes intraocular lens (IOL) pupillary capture. It requires surgical repair to prevent this risk of IOL pupillary capture. However, since repairing cyclodialysis is often technically difficult, other methods such as barricading by suturing, pupilloplasty, and pars plana fixation of the IOL were preferred. We applied a double-flanged (riveting) technique for repairing cyclodialysis to prevent IOL pupillary capture following intrascleral fixation of the IOL. Cyclodialysis was surgically repaired by riveting with double-flanged 6-0 polypropylene sutures in 3 cases with no recurrence of pupillary capture during at least 12 months of follow-up. When pupillary capture is related to cyclodialysis, repairing cyclodialysis may help prevent pupillary capture after intrascleral fixation of the IOL. Riveting using a double-flanged 6-0 polypropylene suture could possibly make the procedure simpler and more efficient.

The multiple radial stromal deep corneal incisions placed in radial keratotomy (RK) lead to higher-order aberrations and pose a surgical challenge to performing any further corrective procedure on the cornea because of fear of inducing an incisional dehiscence. A method to perform pinhole pupilloplasty (PPP) in the setting of previous RK is presented. Application of pinhole optics by performing PPP leads to significant improvement in image quality and helps to optimize visual potential in post-RK cases.

Posttraumatic aphakia is a serious deterrent to visual rehabilitation that usually follows sensory exotropia, thereby mandating urgent surgical intervention. In addition, abnormal iris configuration and iris defects postocular trauma can lead to amblyopia and glare and require surgical correction. However, in individuals where such multiple posttraumatic extraocular and intraocular abnormalities coexist, confusion remains about whether to perform sequential or concomitant surgeries. In these situations, an unusual triple technique consisting of strabismus correction, glued scleral fixation of intraocular lens, and single-pass 4-throw pupilloplasty is a useful cost-effective method of single-stage visual and cosmetic rehabilitation. However, it requires collaboration of experienced surgeons form multiple ophthalmic subspecialties.

Purpose: To describe trocar-assisted method of Nonappositional repair of iridodialysis. Methods: The technique described involves placement of a 25 G trocar at the limbus wherein the lumen of the cannula works as a guide to introduce a double arm polypropylene suture attached to the long arm needle thereby preventing any accidental entrapment of corneal fibers into the needle. Results: The technique was performed in 7 cases and no entrapment of corneal tissue was observed while maneuvering the suture needle through paracentesis incision during an iridodialysis repair procedure. Anterior segment optical coherence tomography demonstrated closure of the limbal trocar wound at 1-week follow-up. No incidence of wound leak or Descemets membrane detachment was observed. Conclusion: The technique allows performing iridodialysis repair in technically challenging situations by directing the needle appropriately and preventing any undulating movement inside the anterior chamber. The trocar-assisted method serves as an effective method to perform non-appositional iridodialysis repair.

Numerous techniques of pupilloplasty have been described to restore iris anatomy. However limitations arise in phakic eyes due to the propensity for crystalline lens damage. We describe a novel technique for pupilloplasty in phakic eyes, wherein a plate haptic intraocular lens or phakic intraocular lens provides a scaffold and protects the anterior crystalline lens from subsequent surgical manoeuvres. The technique is demonstrated in a 24-year-old male who presented four months following blunt trauma to his left eye, with complaints of glare and difficulty in near activities secondary to traumatic mydriasis. The use of an intraocular lens scaffold allowed successful pupilloplasty without iatrogenic tissue trauma or subsequent crystalline lens opacification up to one-year follow-up. Our technique affords a safe pupillary repair without damage to the clear crystalline lens or the need for a concomitant lens extraction.

This technique of performing pinhole pupilloplasty helps filter the straylight from the periphery of the cornea in cases with higher-order corneal aberrations. The pinhole effect blocks distorted and unfocused light rays and isolates more focused central and paracentral rays through the central aperture, thereby reducing aberrations of the optical system as a whole and enhancing visual acuity and its image quality.

Pseudophakic bullous keratopathy is a major deterrent to visual recovery after a complicated cataract surgery. Decentered intraocular lenses (IOLs) incite chronic inflammation that often leads to bullous keratopathy. The triple procedure of glued IOL allows secondary IOL fixation along with single-pass four-throw pupilloplasty that prevents the slippage of air into the vitreous cavity and maintains air tamponade followed by pre-Descemet's endothelial keratoplasty that supplants the endothelial layer, thereby retaining its functionality.

Purpose: To analyze the morphological changes in the iris-knot complex configuration using spectral-domain optical coherence tomography (SD-OCT) following the single pass four throw (SFT) pupilloplasty. Methods: In this retrospective case series, eyes with SFT pupilloplasty were examined by SD-OCT (Optovue). Iris morphology compared to the normal iris, presence of specific patterns (single hump, double humps, peaks and valleys, tethering), prolene suture, knot complex (length and orientation), and intraocular lens (IOL) vault were evaluated. Results: Overall, 41 knots of 26 patients with a mean time duration of 3.1 ± 2 months from surgery were analyzed. Iris configurations seen were single hump (n = 28, 63.8%), double humps (n = 7, 17%), loop (n = 2, 4.8%), flat (n = 3, 7.3%), and mulberry (n = 1, 2.4%). The mean length and the height of the knot complex was 784.1 ± 433.7 μm and 317.7 ± 110.4 μm, respectively. Knot positions were at 3 clock hours in 9 eyes (21.9%), 9 in 8 eyes (19.5%), and others in 24 eyes (58.5%). Cut end of the prolene suture was detectable in 26 eyes (63.4%) as hyper-reflective line, and the mean cut length was 465.8 ± 321.1 μm. The suture was predominantly vertically oriented (80.6%) to the iris with a mean distance of 3.6 ± 0.3 mm (2.6–4 mm) away from corneal endothelium. The mean distance from the knot complex and the IOL was 289.2 ± 146 μm and the mean anterior chamber depth was 4.1 ± 0.1 mm. Conclusion: A significant change in iris configuration was noted after SFT pupilloplasty, and vertically oriented retained prolene suture was predominant with good endothelial vault.

The twofold technique of nonappositional closure of iris defect combined with single-pass four-throw (SFT) pupilloplasty allows adequate closure of defects in varied degrees of iridodialysis, thereby preventing iatrogenically induced problems of glare, photophobia, and eccentric pupil.

Limbal stem cell deficiency (LSCD) can be due to various causes and leads to corneal scarring and neovascularization as a common phenotypic endpoint. Patients require surgical intervention to manage pain/photophobia and restore vision. Patients should have a healthy donor limbus for an autograft, and the cause of LSCD should be resolved to avoid recurrence. Severe causes leading to LSCD might cause concomitant disease requiring further intervention (like keratoplasty, cataract extraction, pupilloplasty, etc.). Patients should be educated about the risks and benefits of the procedure, including alternatives.

Objective: To report a curious case of a posteriorly dislocated large optic fragment that migrated anteriorly to the anterior chamber through a well-positioned scleral-fixated intraocular lens (SFIOL) and intact pupil. Methods: Single case report. Results: The large optic fragment was removed successfully in the operating room. Conclusions: While eyes with a posteriorly-displaced lens or IOL remnants may occasionally be observed without intervention, these patients should be monitored closely., GMS Ophthalmology Cases; 10:Doc06

Purpose: To demonstrate the efficacy and initial results of single-pass four-throw pupilloplasty in cases of Urrets-Zavalia syndrome. Methods: In this prospective interventional study, single-pass four-throw was performed to reconstruct the pupil in all symptomatic cases with Urrets-Zavalia syndrome. Applanation tonometry, indentation gonioscopy, and anterior segment optical coherence tomography for anterior chamber angle assessment were performed in all the cases. Results: Out of 10 cases that were identified with Urrets-Zavalia syndrome, the procedure was performed in 7 cases, whereas 3 cases were left untreated, as they did not have any visual complaints. Five out of seven eyes had preoperative raised intraocular pressure with appositional closure of the angle. Postoperatively, intraocular pressure was controlled in all the eyes, whereas one eye required antiglaucoma medications to control the intraocular pressure. The mean preoperative and postoperative best-corrected visual acuity was 1.1 ± 1.2 and 0.4 ± 0.4 LogMar, respectively. There was a significant improvement in the best-corrected visual acuity (p = 0.0169) in the postoperative period. The mean preoperative and postoperative intraocular pressure was 26.6 ± 11.23 and 16.3 ± 2.98 mm Hg, respectively (p = 0.0168). All the patients had a minimum of 6-month follow-up period (range = 6–8 months). Conclusion: Single-pass four-throw can be employed for cases with Urrets-Zavalia syndrome, and single-pass four-throw helps to prevent the postoperative glare and narrows down the pupil size effectively. Single-pass four-throw helps to alleviate the anterior chamber angle apposition in patients with Urrets-Zavalia syndrome by mechanically pulling the peripheral iris centrally as demonstrated on anterior segment optical coherence tomography. The study also reports the occurrence of Urrets-Zavalia syndrome after glued intraocular lens surgery.

Placement of an anterior chamber iris implant for cosmetic reasons has been associated with development of various complications. Even after the implant has been explanted from the eye, it leaves a trail of after effects that necessitate surgical management. We describe a technique that comprises of performing phacoemulsification with single-pass four-throw pupilloplasty and a pre-Descemet's endothelial keratoplasty procedure for this eye with cosmetic iris implant complication.

Angle-closure glaucoma is characterized by appositional or synechial closure of the anterior chamber angle with glaucomatous field defects that may or may not be associated with a pupillary block. Surgical pupilloplasty with single-pass four-throw technique helps to alleviate the appositional closure along with the breakage of peripheral anterior synechia, thereby increasing the aqueous outflow and decreasing intraocular pressure.

Persistent pupillary membranes (PPMs) are a common congenital anomaly seen in 95% of neonates. Extensive PPMs, occluding the visual axis and resulting in reduced visual acuity, are relatively uncommon. We describe a case of bilateral total PPM in a 36-year-old female who presented with complaints of blurred vision in both the eyes. Dense pupillary membranes obscuring the visual axis need early surgical treatment. It is essential that the lens status remains clear along the visual axis both before and after pupilloplasty.

Four patients with traumatic mydriasis and aphakia following blunt injury of the eye globe were evaluated. Patients with severe glare and photophobia due to wide pupil diameter from 6.0 to 9.0 mm were managed by combined iris cerclage pupilloplasty and retropupillar iris-claw lens implantation. The postoperative anatomic results, visual acuity, subjective degree of glare, photophobia, as well as intraoperative and postoperative complications were evaluated. The mean follow-up time was 32.6 months. Best-corrected visual acuity improved in all patients from preoperative 20/60, 20/30, 20/25, 20/22 to postoperative 20/20, 20/22, 20/20, and 20/20 (Snellen charts). All eyes achieved satisfactory anatomic result with round pupil diameter 3.5–4.5 mm. Glare and photophobia disappeared in all patients. There were no intraoperative or postoperative complications. During the follow-up period, pupils remained round and iris-claw lenses well positioned, without tilting. Combined iris cerclage pupilloplasty with retropupillar iris claw lens implantation appears to be a safe and effective surgical technique in reducing pupil size and improving visual outcomes. It is also a cost- and time-effective procedure, providing great results with a single surgery.

To analyze the pharmacological mydriasis and the consequent fundus visibility after single-pass 4-throw pupilloplasty in pseudophakic eyes.Dr. Agarwal's Eye Hospital, Chennai, India.Comparative case series.Patients with bilateral pseudophakia with single-pass 4-throw pupilloplasty in 1 eye (study) and no single-pass 4-throw in the fellow eye (control) were included. The pupil measurements were analyzed before and after the instillation of mydriatics (tropicamide 0.8%-phenylephrine 5.0% and atropine 1.0%). The dimensions at the baseline and 40, 90, and 120 minutes after instillation were quantified by anterior-segment optical coherence tomography (Visante), a corneal topographer (Orbscan 11z), and an autorefractometer (HRK-7000). The serial photograph (DC3 digital camera) and the fundus imaging (TRC.50DX) were recorded. Changes in pupil size, area, and fundus visibility (50 degrees); the difference in mydriasis between the drugs; and a comparison of mydriasis with the fellow eyes were recorded.The study comprised 22 patients (22 study eyes and 22 control eyes). There was a significant increase in pupil size and area over time (P .0001). The occurrence of mydriasis was higher in the vertical axis (mean 4.5 mm ± 1.3 [SD]) than in the horizontal axis (mean 4.0 ± 1.3 mm) with a significant difference (P = .021). There was a statistically significant difference in pupil dilation between the study eyes and the control eyes (P = .002). The fundus imaging showed good illumination in 13 eyes (59%) and defective illumination in 9 eyes (41%) for retinal visibility.Although pharmacological pupil mydriasis was not equivalent to normal eyes, significant mydriasis occurred and aided in fundus visualization after single-pass 4-throw pupilloplasty.

We describe a pupilloplasty procedure to prevent a captive iris and to narrow the pupillary aperture and its associated complications. We also describe 5 surgical techniques in combination—vertical glued IOL, peripheral iridectomy, anterior sclerotomy, pupilloplasty, and application of a trocar anterior chamber maintainer—performed in eyes with a large WTW diameter; that is, the quintet in glued IOL. Financial Disclosure Neither author has a financial or proprietary interest in any material or method mentioned.

Purpose Several methods have been reported to treat pupil deformities. However, there are some disadvantages to these methods. Here, we introduce the new technique of pupilloplasty. Methods We retrospectively collected five patients who underwent pupilloplasty by radiofrequency diathermy (RFD) in eyes with acorea or a severe pupillary fibrous membrane. The RFD tip was inserted into the anterior chamber after injection of an ophthalmic viscosurgical device (OVD). It was then used to resect the iris and fibrous membrane around the pupillary centre to restore a centred and round pupil. Results No obvious bleeding was observed during resection of the iris or fibrous membrane with the RFD technique. All cases were successfully treated, and pupil transparency was restored. Conclusion We introduced a new technique of pupilloplasty by RFD that is easily manageable, reduces bleeding, and is suitable for most types of pupillary seclusion, especially for acorea and severe pupillary fibrous membrane.

Purpose To report the management of a patient with traumatic mydriasis, aphakia and corneal decompensation with a triple procedure: simultaneous pupilloplasty and retropupillary iris-claw intraocular lens (IOL) implantation combined with Descemet stripping automated endothelial keratoplasty (DSAEK). Results An 88-year-old woman was referred to our Institute for consultation on her left eye. The patient had undergone surgical removal of the IOL, without re-implantation, in her left eye 10 months prior to presentation due to traumatic IOL dislocation. At the time of examination, corrected distance visual acuity was counting fingers and intraocular pressure was 10 mmHg. Slit-lamp examination revealed iridoplegia, aphakia and corneal edema. The patient underwent simultaneous pupilloplasty and retropupillary iris-claw IOL implantation combined with DSAEK. Six months postoperatively, the corneal graft was attached and clear, the iris was well reconstructed and almost round, and the iris-claw IOL was in place. Conclusions Simultaneous pupilloplasty and retropupillary iris-claw IOL implantation combined with DSAEK was shown to be a safe surgical technique in a patient with traumatic mydriasis, aphakia and corneal decompensation.

Aim:The aim of this study is to evaluate the efficacy of pupil cerclage and a new variant of sliding knot technique for repairing traumatic mydriasis.Design:This is a observational case series study.Setting/methods:A series of consecutive patients affected by traumatic permanent mydriasis who underwent pupil cerclage were recruited at the Department of Ophthalmology of the University of Padova, Italy. Best-corrected visual acuity, measured in logarithm of minimum angle of resolution (logMAR), and intraocular pressure at 1, 3, 6, and 12 months were monitored. Postoperative pupil size and anterior chamber angle were measured. Postoperative cystoid macular edema (CME) and glaucoma were evaluated.Results:Twelve patients were recruited. Phakic patients (7) underwent cataract surgery combined with pupil cerclage. Vitrectomy was performed in nine patients. Best-corrected visual acuity improved from 2.9 ± 1.1 logMAR at baseline to 0.3 ± 0.8 logMAR at 12th month. No significant difference between the preoperative and postoperative intraocular pressure was demonstrated. Mean pupil size at 12th month was 2.82 ± 0.5 mm with round shape. Anterior chamber angle mean was 47° ± 4.5°. Six patients developed a CME, and two patients a glaucoma.Conclusion:Pupil cerclage technique reestablishes the pupil with a precise regulation of the pupil size without distortion of its natural round shape. New sliding knot allows surgeon to reduce the risk of iatrogenic iris damage and to make a security permanent knot.

The surgical reconstruction of eyes with iris defects is almost invariably complex and challenging. A number of prosthetic iris devices are available including large-incision, rigid diaphragm, aniridic intraocular lens style devices, small-incision devices incorporating a capsular ring, and flexible, customized, small-incision iris prostheses. The surgical techniques for rehabilitation are dictated by the configuration of the iris defect, the presence of concurrent ocular pathology, and the functional complaint of the patient. Successful rehabilitation requires careful surgical planning and appropriate patient selection. Nonetheless, endowed with the modern surgical armamentarium, the reconstructive surgeon may achieve significant functional and cosmetic improvement.

Mohamed Omar Yousif Department of Ophthalmology, Faculty of Medicine, Ain Shams University, Nasr City, Cairo, Egypt Abstract: Managing large iridodialysis that may occur during phacoemulsification is challenging. I describe how a procedure to reposit a prolapsed iris while the anterior chamber is markedly inflated by a current of infusion fluid may inadvertently lead to large iridodialysis, and discuss how to avoid such a complication. I describe a fast and efficient technique for managing large iridodialysis both immediately, once it occurs, or as a secondary maneuver. My technique involved fixing the iris periphery back to its root at the anterior chamber angle using 10-0 polypropylene suture with two straight needles introduced directly through the cornea at distant points, and an insulin syringe as a guide track to a point 1.5mm from the limbus at the base of a triangular scleral flap that was designed to be centered on the area of iridodialysis. I confirmed the simplicity, efficacy, and safety of my technique through a 1-year follow-up period. Keywords: iridodialysis, iridoplasty, pupilloplasty, phaco complications

PURPOSE To describe a surgical approach of glue-assisted intrascleral fixation of an intraocular lens (IOL) with pupilloplasty and pre-Descemet endothelial keratoplasty as a single-stage procedure. METHODS Glue-assisted intrascleral fixation of an IOL is performed initially because it helps to secure the IOL fixation, followed by pupilloplasty that imparts stability to the anterior chamber and prevents air diversion into the vitreous cavity, thereby facilitating the pre-Descemet endothelial keratoplasty procedure that is performed to complete the surgical repair. RESULTS The procedure was performed in 5 eyes of 5 patients, and the donor age ranged from 9 months to 65 years. There was a significant change in the uncorrected (P = 0.034) and corrected (P = 0.043) distance visual acuities in the postoperative period. The mean graft size was 7.6 ± 0.4 mm (range, 7-8 mm). The mean preoperative and postoperative specular endothelial counts were 2788 ± 204 cells per square millimeter and 1898 ± 90 cells per square millimeter, respectively. No incidence of primary graft failure or graft rejection during the entire follow-up period was reported in any of the eyes. CONCLUSIONS The combined procedure serves as an effective method in select cases of endothelial decompensation that require a secondary IOL implantation or an IOL exchange with good postoperative results.

A young lady presented with very high vault and fixed dilated pupil along with optic capture of the implantable collamer lens (ICL). After thorough evaluation and ruling out the ICL sizing error, the optic capture was relieved and the ICL was rotated into vertical position. Single-pass four throw pupilloplasty was performed for the fixed dilated pupil. Postoperatively the ICL vault and the pupil size decreased and patient was asymptomatic. This case highlights a successful outcome of rotation of a nontoric ICL to reduce the high vaulting and optic capture along with single-pass four throw pupilloplasty.

PurposeTo describe a surgical technique for performing pupilloplasty.MethodsIn this surgical technique for pupilloplasty, after a single pass of needle through the edges of iris defect along the pupillary margin, the suture end is passed through the loop with 4 throws, creating a helical configuration in modified Siepser slipknot technique that is self-retaining and self-locking.ResultsThe technique was performed in 27 cases and the loop did not open in any of the cases in the 6-month follow-up period. No case of iritis was seen. The iris tissue was seen well approximated to each other in all cases.ConclusionsThe single-pass 4-throw technique serves as an effective method to perform pupilloplasty.

Purpose: To describe the feasibility and efficacy of performing single-pass four-throw pupilloplasty for secondary angle-closure glaucoma post silicon oil tamponade. Methods: The procedure was performed in five eyes of five patients. All the cases underwent silicon oil removal with single-pass four-throw pupilloplasty. Single-pass four-throw procedure involves a single pass of needle through the iris tissue that is to be apposed followed by taking four throws by passing the suture end through the loop that is withdrawn from the anterior chamber as in a modified Siepser’s slip-knot technique. Both the suture ends are pulled and this leads to sliding of the loop into the anterior chamber. Surgical pupilloplasty stretches the peripheral iris tissue and helps in breaking the peripheral anterior synechia. Intraoperative gonioscopy and anterior segment optical coherence tomography were performed in all the cases. Results: Intraoperative gonioscopy and anterior segment optical coherence tomography demonstrated opening of the anterior chamber angles with breakage of peripheral anterior synechia. The mean preoperative and postoperative best-corrected visual acuity in logarithm of minimum angle of resolution was 1.24 ± 0.23 and 0.56 ± 0.18, respectively (p Conclusion: Surgical pupilloplasty helps to relieve the post-silicon oil-induced secondary angle-closure glaucoma by breaking peripheral anterior synechia and significantly opening the anterior chamber angles.

A 45-year-old man presented with a Zone I open globe injury of the right eye after being struck by a rock and had prompt surgical repair of the open globe injury within 7 h of his injury. Despite hospital admission for intravenous antibiotics, the patient developed high intraocular pressure post-operatively and a hypopyon was seen on post-operative day 3. He was promptly referred to a retinal specialist and underwent intravitreal tap and injection of antibiotics. Six months after the initial injury, the patient underwent cataract extraction with pupilloplasty. He obtained excellent visual recovery, with a visual acuity of 20/20 1 year after his initial presentation.

Purpose: The purpose of this study is to evaluate the clinical outcomes in patients with traumatic pseudophacocele. Methods: In this retrospective, interventional case series, scleral wound repair with pars plana vitrectomy and glued intrascleral fixation of an intraocular lens (glued IOL) was performed in 5 eyes of 5 patients. Pupilloplasty was performed in 3 cases whereas aniridia glued IOL fixation was done in 1 case that had total avulsion and loss of iris tissue. The main outcome measures were best-corrected visual acuity (BCVA), intraoperative and postoperative complications during the entire follow-up period. Results: The preoperative vision ranged from hand movement to perception of light in all the patients. The mean postoperative BCVA was 0.42 ± 0.21 Snellen's decimal equivalent (SDE) at final follow-up. Postoperatively, all the cases retained good visual acuity with case 1 and case 2 reporting 0.5 SDE, case 3 had 0.33 SDE, case 5 had 0.67 SDE whereas case 4 had a final visual acuity limited to 0.1 SDE due to associated corneal opacity. The mean follow-up period was 20.2 ± 11.7 months (range from 9 months to 36 months). The IOL was well centered, all the wounds were well apposed and the mean postoperative intraocular pressure was 14.6 ± 1.95 mm Hg. No complications were reported in the entire follow-up period. Conclusion: The clinical outcomes of management of pseudophacocele were encouraging with retention of reasonably good visual potential in all cases.

PurposeTo evaluate visual outcomes and complications in scleral fixated intraocular lens (IOL) implantation with the modified Z-suture technique.Materials and methodsThirty-five eyes of 35 patients (20 male, 15 female) were included in the study. Patients underwent scleral fixated IOL implantation using the modified Z-suture technique and were followed in terms of visual acuity and complications.ResultsMean postoperative follow-up time was 12.467.46months. Mean best corrected visual acuity was 1.35 +/- 0.91 logMAR preoperatively and 0.48 +/- 0.39 logMAR postoperatively, and difference was statistically significant (p

We present a case of a 84-year-old man, treated with dexamethasone intravitreal implant (Ozurdex®) for Irvine-Gass syndrome after complicated cataract surgery, with subsequent vitrectomy and retropupillar positioning of iris-fixated intraocular lens. Four weeks after the implantation, the patient presented with the implant in the anterior chamber. To prevent corneal oedema, the implant was removed the day after. After evaluating the anterior segment, the communication between the vitreal cavity and the anterior chamber, through which the implant has migrated, was found (figure 1A). The cystoid macular oedema (CME) reappeared (figure 2A …

Limbal stem cell deficiency (LSCD) can be due to various causes and leads to corneal scarring and neovascularization as a common phenotypic endpoint. Patients require surgical intervention to manage pain/photophobia and restore vision. Patients should have a healthy donor limbus for an autograft, and the cause of LSCD should be resolved to avoid recurrence. Severe causes leading to LSCD might cause concomitant disease requiring further intervention (like keratoplasty, cataract extraction, pupilloplasty, etc.). Patients should be educated about the risks and benefits of the procedure, including alternatives.

To review the changes and results of glued intraocular lens (IOL) procedure in eyes with inadequate capsule.The recent review of 735 eyes with glued IOL showed 486 rigid glued IOL, 191 foldable IOL, 10 glued iris prosthesis, 16 eyes with glued IOL with pupilloplasty and 32 eyes with glued IOL with penetrating keratoplasty. The postoperative best corrected visual acuity (BCVA) in eyes with the rigid glued IOL was 0.38 ± 0.27. There was a significant improvement in BCVA (P = 0.000). The mean postoperative BCVA in foldable glued IOL was 0.39 ± 0.29. IOL optic-related complications included optic capture and decentration. Haptic-related complications seen are haptic extrusion, haptic dislodgement, broken haptic and subconjunctival haptic. Most of the haptic-related problems are due to improper scleral tucking. The second surgeries in rigid glued IOL included IOL repositioning (2.2%), haptic repositioning (1%), conjunctival peritomy closure (0.8%), posterior segment surgery (1.2%) and IOL explantation (0.4%). The surgical modifications included glued IOL scaffold and vertical glued IOL. Glued IOL, which was combined with corneal procedures such as penetrating keratoplasty, Descemet stripping automated endothelial keratoplasty and Descemet's membrane endothelial keratoplasty, showed good visual and anatomical outcome.Glued IOL and its surgical modifications showed good visual outcome with minimal complications in the recent review of its results and complications profile. However, long-term functional and anatomical outcome has to be observed in future.

The aim of this study was to report the efficacy and safety of applying pupilloplasty in combination with Artisan iris-fixated intraocular lens (IOL) implantation in the treatment for aphakia with pathologically large pupil and insufficient capsular support.The study was a retrospective case series.Twenty-six aphakic eyes with pathologically large pupil and insufficient capsular support (from 26 patients) were included in the study.The study patients underwent pupilloplasty in combination with Artisan iris-fixated IOL implantation. Follow-up appointments were scheduled at 1 week and at 1, 3, and 6 months postoperatively.The mean uncorrected visual acuity was significantly improved from logMAR 1.15 ± 0.29 to logMAR 0.37 ± 0.17, and the mean manifest refraction spherical equivalent was significantly decreased from 12.07 ± 2.20 D to -0.69 ± 0.70 D at 6 month after surgery (p0.05). The pupil diameter decreased significantly, from 5.7 ± 1.1 mm preoperatively to 4.5 ± 0.8 mm at 6 months after pupilloplasty (p0.05). Patients experienced less photophobia postoperatively. The safety parameters, including endothelial cell count, intraocular pressure, corneal astigmatism, best-corrected visual acuity, and central corneal thickness, showed no significant differences in values before and after surgery.The Artisan iris-fixated IOL implantation in combination with pupilloplasty can be used as an alternative way to correct aphakia with pathologically large pupil and insufficient capsular support.

The modified McCannel and Siepser techniques allow surgeons to create a locking knot at the extraocular space to maintain a closed chamber. The authors demonstrate that this method made the pupilloplasty easy and applied it to suspend a subluxated intraocular lens with scleral fixation of haptics. [Ophthalmic Surg Lasers Imaging 2010;41:266–271.]

Background: To report a new simplified surgical technique to manage small iris coloboma or traumatic iris defect. Methods: A new surgical technique in which simplified pupilloplasty technique through only a clear corneal paracentesis to manage the iris coloboma or traumatic iris defect within the 120° range was designed. A retrospective revision of the medical records of patients treated with this technique between the years 2013 and 2016 was made. Six eyes of six patients with iris coloboma or traumatic iris defect treated with this new technique were included. Results: All the operated eyes quickly recovered with central round pupil, negligible complications, inessential symptoms of photophobia and glare, and mild inflammation after a median follow-up time of 22 months (range: 6–34 months). Conclusions: The simplified pupilloplasty technique presented here could be a good alternative for the management of small iris coloboma or traumatic iris defect.

A 39-year-old man with Marfan syndrome underwent scleral fixation using a three-piece foldable intraocular lens and experienced repeated pupillary intraocular lens captures secondary to a pliable iris. As a result, the patient needed an additional pupilloplasty. In the opposite eye, a silicone plate haptic intraocular lens was used for scleral fixation because it was thought that the plate design could prevent pupillary intraocular lens capture, even in cases involving a pliable iris. At the 27-month follow-up examination, the patient showed good centration of the intraocular lens in the eye that used the silicone plate haptic intraocular lens without pupillary intraocular lens capture.

PURPOSE This study was designed to study an alternative technique of lamellar separation of corneal layers for therapeutic keratoplasty in place of an en bloc removal of host corneal button in eyes with perforated corneal ulcers with pseudocornea. METHODS Twelve eyes with perforated corneal ulcers with pseudocornea in which therapeutic keratoplasty was planned were included in the study. A new technique was used in which the host corneal tissue was removed in layers by lamellar dissection started peripherally and proceeding centripetally with care taken to prevent perforation at the site of iris incarceration. After injection of viscoelastic into the anterior chamber with a 26-gauge needle entered tangentially, the deeper layer of the cornea was then gently dissected and peeled away from the iris tissue, with care not to avulse the fragile iris and the overlying fibrotic membrane. Adjunctive procedures were performed, and the donor tissue was secured over the host bed. RESULTS A complete separation of the iris tissue from corneal button and the fibrous membrane was achieved in 9 eyes. In 3 eyes, iris was partly trimmed along with the fibrous membrane, because the membrane was totally adherent to the iris tissue. Eight patients required pupilloplasty. Apart from minimal bleeding, no other complication was encountered. At the end of 3 months, 9 of 12 grafts remained clear. CONCLUSIONS Debulking and layer-by-layer removal of host corneal tissue is effective in preservation of iris while performing therapeutic keratoplasty in eyes with perforated corneal ulcers with pseudocornea.

A new modification of the Siepser sliding knot technique allows the surgeon to create a locking knot when performing iris reconstruction or intraocular lens fixation to the iris.

In the pupilloplasty technique, the surgeon creates multiple partial sphincterotomies and stretches the sphincterotomies to enlarge any inadequately dilated pupil so that phacoemulsification can be safely performed. The technique recovers excellent physiologic function and cosmesis postoperatively.