Pupil Sculpting Via Vitreous Cutter In Pediatric Uveitis Complicated Cataract
Published 2026 - 44th Congress of the ESCRS
Reference: POCAT114 | Type: Case Report | DOI: 10.82333/a2js-w855
Authors: Prof. Dr Călin Petru Tătaru* 1 , Dr Cătălina Ioana Tătaru 2 , Dr Cristina Cojan 3 , Dr Maria Cristina Halici 3 , Dr Dinu Bogdan Tiutiucă 3 , Dr Emanuela Băcăoanu 3 , Dr Paul Filip Curcă 4
1Ophthalmology,Central Military Emergency Hospital Dr. Carol Davila, Carol Davila University of Medicine and Pharmacy,Bucharest,Romania;Ophthalmology Compartment I,Clinical Institute for Ophthalmological Emergencies “Prof. Dr. Mircea Olteanu”,Bucharest,Romania;Alcor Clinic,Bucharest,Romania, 2Ophthalmology,Clinical Institute for Ophthalmological Emergencies “Prof. Dr. Mircea Olteanu”, Carol Davila University of Medicine and Pharmacy,Bucharest,Romania;Ophthalmology Compartment I,Clinical Institute for Ophthalmological Emergencies “Prof. Dr. Mircea Olteanu”,Bucharest,Romania;Alcor Clinic,Bucharest,Romania, 3Ophthalmology Compartment I,Clinical Institute for Ophthalmological Emergencies “Prof. Dr. Mircea Olteanu”,Bucharest,Romania, 4Ophthalmology,Central Military Emergency Hospital Dr. Carol Davila, Carol Davila University of Medicine and Pharmacy,Bucharest,Romania
Purpose
Cataract and anterior synechiae formation are complications of uveitis in pediatric patients. Surgery is complex due to pupillary membrane or synechiae or weakening of the zonules. Postoperative follow-up is delicate considering the risk of reoccurring inflammation.
Setting
Retrospective case report.
Report of case
An 18-year-old female patient presented with decrease of visual acuity in both eyes and previous uveitis (6 years ago); and scoliosis. BCVA measured 0.3 decimal 20/80 in the right eye (OD) and counting fingers in the left eye (OS). IOP was 15mm Hg OD, 20 mm Hg OS. The patient presented bilaterally complicated cataracts with anterior synechiae. Cataract surgery was planned first for OS and then for OD. For OS synechiolysis was performed mainly using a spatula, with use of vitreous cutter when adherences were difficult to manage. For OD spatula synechiolysis produced minimal results and as such we proceeded to refashion a functional pupil using the vitreous cutter. An upwards facing position was used to protect the anterior capsule, holding the vitreous cutter between the lens capsule and at the edge or slightly below the iris tissue plane. The inflammatory 360° membrane and a minimal amount of adjacent iris tissue were removed to sculpt a functional pupil. Afterwards we checked pupillary response by injecting mydriatic into the anterior chamber which successfully led to pupil dilation. In both eyes due to weak zonular support we elected to first implant a CTR, followed by toric IOL (OS 19.5 T5 @ 84° K1=42.86 D 84°, K2=39.83 D 174°; OD 21.0 T4 @ 99°, K1=40.33D 9°, K2=42.52 99°). Postoperative vision was 1.0 decimal (20/40) in both eyes with occurrence of Tyndall which was resolved with topical anti-inflammatory treatment. The two surgeries were separated by a 3-month interval.
Conclusion/Take home message
Synechiolysis in uveitis complicated cataract can be successfully resolved by successive use of spatula plus vitreous cutter. The vitreous cutter excels at excising the inflammatory adherence deposits and minimally affects adjacent iris tissue. Once freed the pupil becomes responsive to mydriatic and surgery can proceed quasi-normally. We recommend inserting a CTR as it stabilizes the weakened lens bag, helping the toric IOL to remain on the correct axis postoperatively. Careful follow-up and inflammation management are cornerstones of postoperative care.