![]() Hydrophobic acrylic lenses are at high risk in this respect, with possible zonular or even capsule rupture at the time of implantation.Īlthough this peaked pupil probably will not result in damage to vision, this eye cannot be left unmonitored. Incorrect manoeuvres during surgery can also lead to zonular rupture, more often with small capsulorrhexis during phaco, or during lens implantation if the anterior and posterior chambers are not filled with enough viscoelastic material. Among them, high myopia, pseudoexfoliation and other connective tissue disorders, or previous ocular trauma are the most common causes. Zonular dehiscence or rupture can occur at any time during cataract surgery, especially if there are predisposing factors. Together with the surgical mydriasis, this could explain a round pupil immediately after surgery, and a peaked pupil after 48 hours. The small vitreous strand floating in the anterior chamber at the end of surgery could have been entrapped within the wound at a later time, due to anterior chamber shallowing (eg, a result of eye rubbing). The complication probably occurred during the last surgical phases, which explains why the surgeon might have been unaware. Since we are told surgery was uncomplicated, we must assume a zonular dehiscence or rupture occurred during phacoemulsification or lens implantation. The rupture of the posterior capsule or rupture of the zonular fiberscan produce a small vitreous strand within the anterior chamber. The vitreous strand is incarcerated into the corneal wound, thus maintaining the peaked pupil. This eye has a peaked pupil as the result of a vitreous strand that is clearly visible in Figure 1. ![]() What are the possible causes of this? Could it have been prevented? How would you manage this problem? Unfortunately, it persisted, and the pupil remains peaked (Figure 1). ![]() On the second or third day postop, however, the patient noticed that her pupil was distortedbut because her vision was stable and there were no other symptoms, she assumed this would settle down. According to the clinical record, the patient had an UCVA of 20/30 with no complications on day 1 postop review. You are asked to see a female patient, aged 53 years, who underwent uncomplicated phacoemulsification in her right eye, through a temporal clear corneal incision 2-weeks previously. Wavescan-Guided Bilateral Multifocal Surface Ablation PresView: A Treatment for Phakic and Emmetropic PatientsĪcuFocus Intracorneal Lens Generating Strong Outcomes Laser Presbyopia Reversal: An Alternative Procedure Treating Presbyopia With New Multifocal IOLsįunctional Vision With a Dual Optic Accommodating IOLĬonductive Keratoplasty: A Surgical Management Option for Presbyopia Presby-LASIK and the State of Presbyopia Correction Prevention of Corneal Ectasia in Refractive SurgeryĪspheric Algorithms and Quality of Vision History of Ophthalmic Viscosurgical Devices Routine Use of Microcoaxial Torsional Phaco
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