Address pupil ovalization after IOL implantation promptly

Lisbon, Portugal – Pupil ovalization after implantation of IOLs is a rare occurrence. However, when it develops, it must be addressed immediately and effectively, according to Antonio Marinho, MD, PhD, of the University of Porto, Portugal.

Dr. Marinho reported a challenging case of pupil distortion in a 25-year-old female patient. The woman had undergone IOL implantation in 1994 because of a case of high myopia (–14 D). Her best-corrected visual acuity was 20/30 before surgery. The uncorrected visual acuity was 20/25 with the IOL implanted. In 2003, when the patient presented for a routine examination, the pupil was distorted, and there was important iris atrophy; however, the patient had no glare and did not have any visual complaints.  The IOL had to be removed despite lack of symptoms.

Dr. Marinho explained Saturday at the European Society of Cataract and Refractive Surgeons that there are a few management options in such cases that include observation, rotation of the IOL, and explanation of the IOL. The first two were no options in this case. Regarding explantation, in this case he opted for replacing the IOL with another phakic IOL and avoided the areas of iris atrophy. Partial reversibility of the pupil distortion occurred.

He urged that pupil distortion be addressed adequately when these rare cases develop.

“Don’t wait for atrophy to develop,” he underscored.