Ectopic pupil repair by Steven G. Safran MD

This patient was a 52 year old who had a ruptured globe 40 years earlier with the top third of his iris incarcerated in the wound. He then had cataract surgery done elsewhere 3 years previously and had monocular diplopia and poor vision because he was looking through the haptic optic junction. There were vitreous strands adherent to the iris where it was incarcerated seen on gonioscopy that were treated with a YAG laser prior to this surgery. My goal was to reposition his pupil and preserve the 2/3 of a functioning iris sphincter that he had inferiorly so that he would still have pupil function. We did achieve that goal along with a marked improvement in cosmesis, resolution of monocular diplopia and 20/20 corrected Va. A YAG capsulotomy was done one month after this procedure was performed. Note the use of iris retractors to pull the inferior pupil down as the superior pupil is sutured closed. You can see the inferior 2/3 of iris sphincter has been preserved throughout the procedure. Also note that I'm sitting on the temporal side during this surgery and do adjust my seating position a bit during the case rotating the microscope to allow a better "angle of attack". Please note that if you turn the screen 90 degrees counterclockwise at the end of the procedure to view it in the normal "slit lamp" orientation you can see that the centration of the pupil is excellent when the case is finished.

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[sgsafran]

Yes. His vision was fine and his eye looked essentially normal but the iris has somewhat limited (although improved) function compared to normal. There was some loss of muscle tissue due to his original trauma and atrophy from disuse since that could not be completely repaired. The patient was very happy with the outcome.

[motodoc8]

great video--what needle/suture did you use, and what size needle did you use when capturing the suture needle?

[sgsafran]

Thanks. I used a 10-0 prolene on CIF-4 needle. I captured it with an MST 23 gu microforceps (not a needle). I find this gives me better control than a needle.

[unknownregect]

I'm 16 and was born with ectopic pupils. This video showed up while I was doing research. I'm kind of grossed out now. I think i'm just going to deal with my abnormal pupils. O_o

[mariteri15000]

Was the patient able to make a full recovery?

[Roxrockereyl]

wow pretty amazing

[fVc4FACE]

@asianboy515 no

[asianboy515]

i have iritis sometimes my puipils tend to get big & makes me have blurry vision..should i get this done?