Ectopic pupil repair

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.