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New onset of corectopia mystery
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 Inferior peaked pupil 2 months after routine cataract surgery with a temporal incision. |
This patient underwent routine cataract surgery a few months ago, and she did remarkably well, achieving 20/15 vision and a plano result, but now the pupil is irregular. The surgery was performed via a temporal clear corneal incision under topical anesthesia. There were no intraoperative complications, and the pupil was normal and round after surgery. She underwent a conservative YAG laser capsulotomy for early capsular opacity and did well. There is no iris incarceration in the wounds (temporal incision, inferior peaked pupil), and there is no vitreous prolapse (the posterior capsulotomy is smaller than the optic, the anterior rhexis is intact and of an appropriate size and shape).
But then, about 4 to 6 weeks after the surgery, she noted a slight corectopia with an apparent weakness of the inferior iris sphincter at the 6 o'clock position. A photo of her left eye is shown here. The pupil is reactive, and pilocarpine brings the pupil down but still with a corectopia.
The patient's only other symptoms are related to reflections from the IOL surface, and these resolve fully with pharmacologically induced miosis. There are no other symptoms and no evidence of other microvascular or neurological lesions in either eye.
What is the cause of this corectopia? I look forward to your suggestions.
See Dr. Devgan share more expert insight live at OSN New York 2010, to be held November 19-21, 2010 at the Sheraton New York Hotel & Towers. Learn more at OSNNY.com.