DYSPHOTOPSIA DUE TO RETAINED CAPSULORHEXIS MEMBRANE ADHERING TO PUPILLARY MARGIN IN PIGMENTARY GLAUCOMA.

To describe a case of successful treatment of dysphotopsia induced by retained capsular rhexis fragment after standard uncomplicated phacoemulsification.

Southampton Eye Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.

Fifty-year-old office worker with medically well controlled pigmentary glaucoma presented with reduced visual acuity secondary to cataract. She underwent a standard uncomplicated phacoemulsification with predicted post operative refraction aimed at myopia as per her needs. She presented to our emergency unit with flashes and was noted to have peaking of pupil at three o’clock and suspected vitreous like strand and no active inflammation. Dilated fundoscopy revealed no retinal breaks and healthy peripheries.

Patient underwent a further procedure with planned anterior vitrectomy to release the supposably tractional element. A Kenalog injection did not identify any vitreous. A sweep above and below the iris did not show any obvious traction. Attempt with the vitrector or Simcoe aspiration did not remove the transparent membrane. This was possibly a retained capsular rhexis membrane adhering to the iris. Grasping with forceps countered with traction by ironing out iris released this membrane (figure 2) leading freeing the pupillary margin to natural contour.  This relieved the symptoms of the flashes and she recovered with vision of 6/5.

Dysphotopsia due to peaking at pupil from a capsular membrane adhered to iris was successfully relieved shows the significance of removal of the capsular rhexis disc completely before commencing further steps of the surgery, especially in pigmentary glaucoma.