Unilateral mid-dilated reactive pupil after same session bilateral toric Implantable Collamer Lens implantation

Abstract

We present a case of the unilateral mid-dilated reactive pupil to both light and near reflexes after uneventful refractive surgery of a healthy 32-year-old female patient who was diagnosed as a case of nonprogressive kertoconus (KC) and planned for surgical correction of astigmatism with toric Implantable Collamer Lens (tICL). On 1 st postoperative day, we noticed that there was anisocoria with right pupil being mid-dilated and left pupil of normal diameter. Both pupils react to light with the same degree of anisocoria in photopic and mesopic conditions. Intraocular pressure (IOP) was 14 mmHg in both eyes, although slight elevation of IOP occurred 1 h after surgery that had been self-limited 3 h postoperatively, and the patient was discharged without prescribing IOP lowering agents. Slit lamp examination revealed formed an anterior chamber with normal depth and cells +3 in the right eye and +2 in the left eye, ICL was well-centered in both eyes with normal vault and no posterior segment abnormalities were found. To our knowledge, this is the first case to be reported with the same findings after same session bilateral tICL implantation as a refractive surgery in nonprogressive KC patient. The patient was diagnosed with reversible Urrets-Zavalia syndrome (UZS) pupil in the right eye.