Refractive Surprise: IOL Scaffold with Pinhole Pupilloplasty

In this case, a patient who had undergone LASIK 15 years prior developed spherical error, higher-order aberrations, and astigmatism after receiving a toric multifocal IOL. To address these issues, Dr. Amar Agarwal first performs an IOL exchange using an IOL scaffold technique. In this approach, the original IOL is brought into the anterior chamber and temporarily left in the eye while the new IOL is implanted behind it. The original IOL is then bisected and removed without fear of damaging the posterior capsule. Dr. Agarwal then performs a pinhole pupilloplasty, in which several single-pass, four-throw pupilloplasties are performed to reduce the size of the pupil, thereby extending the patient's depth of focus and eliminating the need for glasses.