Posters

Siepser sliding suture for scleral-fixated IOL pupillary capture

Poster Details

First Author: S.Neary IRELAND

Co Author(s):    K. Kennelly                    

Abstract Details

Purpose:

Herein we describe the use of the Siepser sliding suture technique in the management of a case of pupillary capture of a scleral-fixated IOL.

Setting:

Case report.

Methods:

A 37 year-old gentleman with high myopia underwent left cataract surgery. He previously had three retinal detachment repairs in that eye: two cryo-buckles and one vitrectomy. Phacoemulsification and irrigation/aspiration of the soft lens matter was completed from an anterior approach. However, six-clock-hours of zonular loss was noted, precluding placement of either an IOL in the capsular bag or in the sulcus. It was decided to convert to a posterior approach. A 25G pars plana vitrectomy approach was set up and the lens capsule was removed. A scleral-fixated IOL was placed using an MA60AC IOL and the Yamane technique.

Results:

One week postoperatively, the patient presented with a painful eye and headache and was found to have 4 clock hours of nasal pupillary capture and 6 clock hours of temporal pupillary capture. The lens was repositioned in theatre under local anaesthetic. The patient represented twice more with pupillary capture despite regular topical pilocarpine therapy. To address this, the pupillary aperture was reduced using two Siepser sliding sutures with 10-0 prolene. Following the pupilloplasty, there were no further episodes of pupillary capture.

Conclusions:

Intermittent pupillary capture of scleral-fixated IOLs has a reported frequency of up to 7.9% in some series. Although usually transient, patients may be symptomatic with blurred vision or pain and complications such as pupillary block and iritis with secondary glaucoma may occur. Medical management with miotic agents or laser iridotomy for pupillary block have relatively low success rates and the problem may recur. An advantage of the Siepser sliding suture for pupilloplasty is that it only requires paracentesis incisions rather than a main incision. A 10-0 prolene suture is preferred. This technique provides excellent stability in maintaining IOL position.

Financial Disclosure:

None