Pupillary Capture

Postoperative pupillary capture of the IOL optic can occur for various reasons, such as formation of synechiae between the iris and underlying posterior capsule, improper placement of the IOL haptics, shallowing of the anterior chamber, or anterior displacement of the PCIOL optic. The last of these is associated with placement of nonangulated IOLs in the ciliary sulcus, upside-down placement of an angulated IOL so that it vaults anteriorly, excessive Soemmering ring formation, or asymmetric capsule contraction. Placement of a posteriorly angulated PCIOL in the capsular bag and creation of an anterior capsulorrhexis smaller than the lens optic decrease the likelihood of pupillary capture.

Pupillary capture may be simply a cosmetic concern. If the condition is chronic and the patient is asymptomatic, it can be left untreated. Surgical repositioning of an IOL may be indicated if pupillary capture causes glare, photophobia, chronic uveitis, unintended myopia, or monocular diplopia. In an acute pupillary capture, pharmacologic manipulation of the pupil with the patient in the supine position sometimes frees the optic. If conservative management fails, surgical intervention may be required to free the iris, lyse synechiae, manage capsule contraction or residual lens proliferation, and reposition the lens (Fig 11-11).

Figure 11-9 Illustration of intrascleral glued haptic IOL fixation. A, Scleral flaps are created 180° apart. Intrascleral Scharioth tunnels are created parallel to the limbus with a bent 26-gauge needle. B, A 3-piece foldable IOL is injected into the eye while a microforceps is used to grasp the leading haptic and externalize it. Similarly, the trailing haptic is then externalized under the opposite scleral flap. C, The haptics are tucked into intrascleral tunnels. D, The flaps and conjunctiva are sealed with tissue glue.

(Illustration courtesy of Mark Miller.)

Excerpted from BCSC 2020-2021 series: Section 11 - Lens and Cataract. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.