Endodiathermy-Assisted Pupilloplasty For Correction Of Traumatic Pupillary Irregularity

To present a successful case demonstrating endodiathermy-assisted pupiloplasty in combined anterior and posterior segment reconstruction after long-standing ocular trauma.

Department of Ophthalmology, Hospital of Lithuanian University of Health Sciences, Kaunas Clinics

A 74-year-old man presented with poor vision in his right eye, resulting from an ocular injury sustained 50 years ago in Ukraine. His best-corrected visual acuity was limited to light perception, and he had 45-degree exotropia. Slit-lamp examination showed a clear cornea with an inferior peripheral scar near the limbus, a shallower inferior anterior chamber, iris traction toward the scar, an irregular and inferiorly decentered pupil, and a completely opacified lens with a fibrotic capsule behind the iris. Fundus reflex was absent, but B-scan ultrasonography confirmed an intact retina.

Owing to extensive anterior segment abnormalities and inability to visualize the posterior segment, surgical intervention including pupiloplasty was considered, though prognosis remained uncertain. The patient underwent intracapsular cataract extraction with vitrectomy, followed by implantation of a three-piece intraocular lens via the Yamane transscleral fixation technique. Iridoplasty was performed using endodiathermy with a 10-0 polypropylene suture and the Single-Pass Four-Throw technique, facilitating pupil centralization and enlargement. Pupil centration and diameter were guided intraoperatively using a microscope-integrated measurement system.

Two months postoperatively, his BCVA improved to 20/30 with a 2.5 mm pupil and exotropia reduced to approximately 30 degrees. Postoperative diplopia was transient and resolved within two months.

This case demonstrates that combined anterior and posterior segment surgery can achieve substantial visual improvement even in eyes with long-standing traumatic pathology. The use of endodiathermy-assisted iridoplasty allowed effective pupil reconstruction in the presence of significant iris fibrosis and traction, providing a stable and well-cantered pupil. Visual restoration can unmask preexisting but compensated ocular misalignment, with subsequent development of strabismus and diplopia. This underscores the importance of comprehensive preoperative counselling and postoperative monitoring of binocular vision.