Novel maneuver for the alleviation of pseudophakic optic capture and consequent pupillary block: A case report and technique

Abstract

Posterior chamber pseudophakic pupillary block (PPB) due to anterior optic capture is a rare condition with possible grave consequences. It can lead to extremely elevated intraocular pressure (IOP) and absence of anterior chamber space which may preclude the use of standard treatment methods. We describe a novel technique for its alleviation. An 80-year-old woman presented to a tertiary medical center with the left pupillary block 3 months after implantation of an intraocular lens (IOL) in the ciliary sulcus and 3 days after routine evaluation for age-related macular degeneration with tropicamide 0.5%. By exerting manual pressure on the corneal surface, the inferior half of the IOL optic was reduced into the posterior chamber, creating sufficient space for immediate Neodymium:Yttrium-Aluminum-Garnet (Nd:YAG) peripheral iridotomy. After IOP dropped to 20 mmHg, the upper half of the IOL optic was reduced into the posterior chamber using a Sinskey hook inserted through a single limbal paracentesis, and the anterior chamber was filled with an ophthalmic viscoelastic device. The device was subsequently aspirated and 1% acetylcholine was injected to constrict the pupil above the IOL optic. There were no operative complications. The corneal edema resolved, with normal cupping of the optic nerve head. At 3 months, the IOP was stable at 14–18 mmHg. The maneuver described to allow for laser treatment of PPB is technically simple and non-invasive and was highly successful in an 80-year-old patient. Repositioning the pseudophakic IOL optic may be planned as a subsequent, non-urgent procedure.