Pupillotonia after endolaser retinopexy during vitrectomy for retinal detachment: a prospective cohort study comparing circumferential and focal retinopexy.

PURPOSE: To determine differences in postoperative pupil diameter in eyes that undergo pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) with endolaser retinopexy (ELR), comparing 360° vs focal ELR. METHODS: Patients with uncomplicated RRD who underwent PPV were prospectively analysed regarding the postoperative pupil diameter difference (PDD) between the affected eye and the partner eye. Group 1 underwent 360° ELR and group 2 received focal ELR. Postoperative vision and complications, including redetachment rate, macular oedema and epiretinal membrane formation, were also compared. RESULTS: A total of 72 patients, 42 in group 1 and 30 in group 2, were analysed. PDD, as observed at 6 weeks, was significantly greater than the preoperative values in both groups 1 and 2. It increased by a mean of 1±1.11 mm in group 1 and by 0.5±0.78 in group 2. This initial increase in PDD receded over time, but remained statistically significant in both groups, even at 6 months. The top 20% of patients with the largest PDD change comprised 13 out of 15 eyes from group 1, which was a statistically significant overrepresentation (p=0.0435). CONCLUSIONS: Moderate pupillotonia was induced post-ELR in vitrectomy and correlated to the extent of ELR. The pupillotonia effect of ELR was significantly less marked in pseudophakic eyes.

Phacoemulsification with implantation of Morcher aniridia capsular rings for postoperative atonic pupil after iridencleisis--case report.

INTRODUCION: Large iris defets, anirdia or wide atonic pupil may cause disturbing photoptic phenomena my require surgical treatment. In acquired iris defects, ophthalmologists have a relatively wide choice of therapeutic strategies, which depend on the size and etiology of the defect and the comorbidities. The goal of treatment is to restore iris diaphragm and to reconstruct the pupil in order to prevent glare and to increase the quality of perceived image. CASE REPORT: We present a case of cataract and unilateral wide, atonic pupil in a patient 39 years after iridencleisis, who complained of intense glare in the left eye and photophobia ever since. The patient was successfully treated by phacoemulsification through a 2.75 mm clear corneal incision with implantation of two black Morcher aniridia capsular rings. The patient experienced a significant improvement in her subjective quality of vision and a constant glare that she had been experiencing for years resolved. CONCLUSION: The presented case indicates that Morcher aniridia capsular rings may be a good tool instrument to assist the surgeon in cases of cataract concomitant with wide and atonic pupil. Using these rings reduces glare and improves the subjective quality of patients' vision.

Surgical treatment of ventral mesencephalic cavernoma.

The treatment of an intrinsic midbrain tumour has always been controversial due to the precarious nature of its location. We report a rare example of a cavernoma located in the ventral mesencephalon and presented clinically as Holmes' tremor. In order to access this vital portion of midbrain, we chose a fronto-temporal trans-sylvian route via an orbito-zygomatic craniotomy. The cavernoma was removed en bloc with a longitudinal pial incision between the fronto-pontine fibers and the pyramidal tracts in the peduncle. After the operation, the tremor dramatically disappeared. Through a review and analysis of the literature, we discuss the surgical strategy for management of an anterior midbrain cavernoma. With an optimal surgical approach, fairly safe entry zones on the anterior face of the rostral brainstem may be accessible, which makes it possible for successful resection of a ventral mesencephalic cavernoma without postoperative complications.

Small incision single-suture-loop pupilloplasty for postoperative atonic pupil.

In this small incision technique to correct postoperative atonic pupil in the aphakic or pseudophakic eye, the pupil is sutured and constricted with a 10-0 polypropylene loop through 3 1.0 mm stab incisions. The surgery is easier to perform than previous methods, appears safe and reproducible, and requires little special equipment. Although the pupil's shape may become slightly irregular, its size is fairly easy to regulate. This new method should be useful in correcting postoperative atonic pupil, and the small incision technique will likely minimize surgical trauma and induced astigmatism.