2964: fixing a closed pupil from uveitis
This case presents a severe case of pupillary occlusion (seclusio and occlusio pupillae) secondary to chronic uveitis, where the patient’s vision has been reduced to light perception. Our operating guest surgeon takes a highly aggressive approach to managing this fibrosed, non-reactive iris tissue. The surgeon first forcefully expands the tightly closed pupil to break the extensive posterior synechiae. To maintain adequate visualization during the phacoemulsification, a combination of both a B-Hex pupil expansion ring and an iris hook is utilized. While this dual-expansion technique successfully provides the required surgical view to complete the cataract extraction, the intense mechanical stretching leaves the iris permanently damaged. Following the procedure, the iris is left in a state of mydriasis with a loss of muscular tone. While the cataract was safely removed, leaving the pupil wide open can lead to significant postoperative glare and photophobia. Performing a suture pupilloplasty at the conclusion of the case would have been an excellent addition to restore proper pupil size and structure, though this guest surgeon chose not to do so. What would you have done? please comment below.
