gms | German Medical Science

We describe the use of the PerfectPupil™ system in cataract surgery in 3 eyes of 2 patients presenting with an iridoschisis. In iridoschisis patients the iris plane is divided in several horizontal layers, with some longer iris fibres floating in the anterior chamber. This may results is aspiration of iris tissue during surgery and damage of the iris.

The first patient was a 83-years-old male with a nuclear cataract, pseudoexfoliation syndrome and iridoschisis. This patient also was under systemic anti-coagulation therapy. The best corrected preoperative visual acuity was OD: 0.05, OS: 0.08. The second patient was a 73-years-old mentally retarded male with a brunescent cataract on the right eye. Preoperatively the best corrected visual acuity was 0.1.

In the first patient cataract surgery was performed in both eyes in topical anaesthesia by a clear-cornea incision. Intraoperatively, pupil size was 3mm, the PerfecPupil device was inserted manually and was fixated at the iris rim leading to a pupil dilation of 6 mm. Cataract surgery was performed uneventful without any damage to the iris. Hydrophobic acrylic foldable intraocular lenses were implanted by forceps. Postoperative visual acuity was best corrected OD 0.5 and OS 0.4, respectively. The other patient was operated in general anaesthesia. Again the pupil dilation was successfully achieved. The brunescent cataract was removed and a hydrophobic acrylic IOL was planted with an injector resulting in a postoperative visual acuity of 0.3 uncorrected.

In cases with iridoschisis there is always a danger of aspirating iris fibers during the different steps of cataract surgery. In these three cases this was completely prevented by the PerfectPupil™ system