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An unusual pupil
 Star-shaped pupil. |
As ophthalmologists, we often focus on visual function first, with less concern given to the cosmetic result. In cataract surgery, this means that we want to achieve a specific refractive outcome with the IOL placed securely in the capsular bag. But there can be cosmetic consequences to our surgery, such as iris or pupil deformities.
Particularly with beginning surgeons, there is a chance of iris damage during the cataract procedure, from iris prolapse through the wound to aspiration of iris with the phaco handpiece. In cases of small pupils, pupil stretching or sphincterotomies can lead to a permanent corectopia.
This patient underwent routine cataract surgery; however, multiple small sphincterotomies were performed in order to help expand a small pupil. In an eye with a dark brown iris, this may not even be visible.
However, with this blue iris, it was so visible that the patient would notice it when looking in a mirror, and she felt that it was disruptive to her acting career.
I'm not sure that I have a definitive solution to address her concerns. Any suggestions?