Abstract
Most, if not all, ophthalmologists strive to achieve a round pupil after cataract surgery with posterior chamber lens implantation. The presence of pupil abnormalities and iris modifications is cosmetically undesirable and may affect the quality of postoperative vision. The pupillary motility may be changed which will in turn affect both pupillary light reflexes and pupillary dilatation during fundus examination. In this paper, we prospectively studied 2 groups of patients who underwent uncomplicated cataract surgery with posterior chamber lens implantation; 100 patients who had planned extracapsular cataract extraction (ECCE), and 130 patients who underwent phacoemulsification. On the first postoperative day, we found a 16% rate of pupil abnormalities in the group which underwent ECCE surgery while only 5.3% of the phacoemulsification group had pupil abnormalities. There were different causes in which the two groups. The most common cause of pupil abnormality after ECCE was due to iris sphincter rupture, whereas the most common cause after phacoemulsification was due to iris trauma during phacoemulsification. These pupil abnormalities are the direct consequence of factors in surgery and we suggest ways to minimize the occurrence of such abnormalities in cataract surgery.
Similar content being viewed by others
References
Apple DJ, Mamalis N, Loftfield K et al. Complications of intraocular lenses. A historical and histopathological review. Surv Ophthalmol 1984; 29: 1–54.
Kratz RP, Mazzocco TR, Davidson B, Colvard DM. A comparative analysis of anterior chamber, iris-supported, capsulefixated, and posterior chamber intraocular lenses following cataract extraction by phacoemulsification. Ophthalmology 1981; 88: 56–8.
Jaffe NS. The changing scene of intraocular implant lens surgery. Am J Ophthalmol 1979; 88: 819–28.
McDonnel PJ, Green WR, Maumenee AE, Iliff WJ. Pathology of intraocular lenses in 33 eyes examined postmortem. Ophthalmology 1983; 90: 386–403.
Stark WJ, Terry AC, Worthen D, Murray GC. Update of intraocular lenses implanted in the United States. Am J Ophthalmol 1984; 98: 238–9.
Baller RS. Opacification of the posterior capsule- an alternative to discission. Ophthalmic Surg 1977; 8(6): 48–50.
Lindstrom RL, Harris WL. Management of the posterior capsule following posterior chamber lens implantation. Am Intraocular Implant Soc J 1980; 6: 255–8.
McDonnell PJ, Zarbin MA, Green WR. Posterior capsule opacification in pseudophakic eyes. Ophthalmolgy 1983; 90: 1548–53.
Stark WJ, Bruner WE, Martin NF. Management of subluxed posterior-chamber intaocular lenses. Ophthalmic Surg 1982; 13: 130–3.
Boke WRF, Kruger HCA. Causes and management of posterior chamber lens displacement. Am Intra-ocular Implant Soc J 1985; 11: 179–84.
Fava GE, Kline OR Jr. Decentration of posterior chamber lenses. Am Intra-ocular Implant Soc J 1982; 8: 247–50.
Smith PW, Stark WJ, Maumenee AE et al. Retinal detachment after extracapsular cataract extraction with posterior chamber intra-ocular lens. Ophthalmology 1987; 94: 495–504.
Schultz RO, Glasser DB, Matsuda M et al. Response of the corneal endothelium to cataract surgery. Arch Ophthalmol 1986; 104: 1164–9.
Kraff MC, Sanders DR, Lieberman HL. Monitoring for continuing endothelial cell loss with cataract extraction and intraocular lens implantation. Ophthalmology 1982; 89: 30–4.
Wright PL, Wilkinson CP, Balyeat HD et al. Angiographic cystoid macular edema after posterior chamber lens implantation. Arch Ophthalmol 1988; 106: 740–4.
Layden WE. Pseudophakia and glaucoma. Ophthalmology 1982; 89: 875–9.
Samples JR, Van Buskirk EM. Pigmentary glaucoma associated with posterior chamber intraocular lenses. Am J Ophthalmol 1985; 100: 385–8.
Gibbens MV, Goel R, Smith SE. Effect of cataract extraction on the pupil response to mydriatics. Br J Ophthalmol 1989; 73: 563–5.
Lippman JI. Pupillary abnormalities associated with posterior chamber lens implantation. Ophthalmic Surg 1982; 13: 197–200.
Brazitikos PD, Roth A. Iris modifications following extracapsular cataract extraction with posterior chamber lens implantation. J Cataract Refract Surg 1991; 17: 269–80.
Johnson SH, Kratz RP, Olson PF. Iris transillumination defect and microhyphema syndrome. Am Intra-ocular Implant Soc J 1984; 10: 425–8.
Saiz A, Angulo S, Fernandez W. Atonic pupil: an unusual complication of cataract surgery. Ophthalmic Surgery 1991; 22(1): 20–2.
Tani M, Hayakawa J. Irreversible mydriasis following posterior chamber lens implantation. Jpn J Clin Ophthalmol 1987; 41: 433–7.
Lam S, Beck RW, Hall D, Creighton JB. Atonic pupil after cataract surgery. Ophthalmology 1989; 96: 589–90.
Golnik KC, Hund PW, Apple DJ. Atonic pupil after cataract surgery. J Cataract Refract Surg 1995; 21: 170–5.
Lavin M, Jagger J. Pathogenesis of pupillary capture after posterior chamber intraocular lens implantation. Br J Ophthalmol 1986; 70: 886–9.
Lindstrom RL, Herman WK. Pupil capture:prevention and management. Am Intra-ocular implant Soc J 1983; 9: 201–4.
Miller SD. Total pupillary capture. Am Intra-ocular Implant Soc J 1983; 9192-3.
Nakazawa M, Ohtsuki K. Apparent accomodation in pseudophakic eyes after implantation of posterior chamber intraocular lenses. Am J Ophthalmol 1983; 96: 435–8.
Masket S. Relationship between postoperative pupil size and disability glare. J Cataract Refract Surg 1992; 18: 506–7.
Michels RG, Glaser BM. Surgical treatment of postoperative dilated non-reactive pupils in eyes after combined pars plana lensectomy and vitrectomy. Retina 1990; 10: 205–8.
Patz A. Photocoagulation of retinal, vascular and macular diseases through intraocular lenses. Ophthalmology 1981; 88: 398–406.
Monson MC, Mamalis N, Olson RJ. Toxic anterior segment inflammation following cataract surgery. J Cataract Refract Surg 1992; 18: 184–9.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Yap, E.Y., Aung, T. & Fan, R.F.T. Pupil abnormalities on the first postoperative day after cataract surgery. Int Ophthalmol 20, 187–192 (1996). https://doi.org/10.1007/BF00175258
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00175258