Pupillary capture after combined management of cataract and vitreoretinal pathology

Purpose: To report the incidence, pathogenesis, and management of pupillary capture after combined phacoemulsification with intraocular lens (IOL) implantation and vitreoretinal surgery. Setting: Oxford Eye Hospital, The Radcliffe Infirmary, Oxford, United Kingdom. Methods: This retrospective case review comprised 12 patients who developed pupillary capture after combined phacoemulsification, IOL implantation, and pars plana vitrectomy (PPV). Eleven IOLs were implanted in the capsular bag, and 1 was sulcus fixated. All patients had a long-acting gas tamponade and were advised to lie face down postoperatively. All patients subsequently had IOL repositioning using a bimanual technique. Results: The incidence of pupillary capture was 8.95% and occurred a mean of 3.25 weeks postoperatively. At least 6 clock hours of the pupillary margin were captured by the optic except in 1 case in which the pupillary capture was total. Half the patients had posterior capsule opacification that required a neodymium: YAG laser capsulotomy after IOL repositioning. Conclusions: The incidence of pupillary capture after combined phacoemulsification, IOL implantation, PPV, and injection of long-acting gas was high. This complication can be minimized by creating a smaller capsulorhexis, having the patient maintain a strict face-down position, securing wound closure, and injecting an air bubble into the air chamber to push the iris-lens diaphragm posteriorly.