Pupillary capture after combined management of cataract and vitreoretinal pathology

Abstract

Purpose To report the incidence, pathogenesis, and management of pupillary capture after combined phacoemulsification with intraocular lens (IOL) implantation and vitreoretinal surgery. Setting Oxford Eye Hospital, The Radcliffe Infirmary, Oxford, United Kingdom. Methods This retrospective case review comprised 12 patients who developed pupillary capture after combined phacoemulsification, IOL implantation, and pars plana vitrectomy (PPV). Eleven IOLs were implanted in the capsular bag, and 1 was sulcus fixated. All patients had a long-acting gas tamponade and were advised to lie face down postoperatively. All patients subsequently had IOL repositioning using a bimanual technique. Results The incidence of pupillary capture was 8.95% and occurred a mean of 3.25 weeks postoperatively. At least 6 clock hours of the pupillary margin were captured by the optic except in 1 case in which the pupillary capture was total. Half the patients had posterior capsule opacification that required a neodymium:YAG laser capsulotomy after IOL repositioning. Conclusions The incidence of pupillary capture after combined phacoemulsification, IOL implantation, PPV, and injection of long-acting gas was high. This complication can be minimized by creating a smaller capsulorhexis, having the patient maintain a strict face-down position, securing wound closure, and injecting an air bubble into the air chamber to push the iris–lens diaphragm posteriorly.