Contact lens for failed pupilloplasty Carpi Olali, BMedSci, MBBS, FWACS, FRCS, Mustapha Mohammed, MD, Sohail Ahmed, MBBS, DO, FRCS, FRCOpth, Mohit Gupta, MBBS, FRCS We present a case of a patient who had pupilloplasty for an atonic pupil following phacoemulsi- fication cataract surgery. Postoperatively, the patient experienced glare that was not relieved by a neodymium:YAG laser capsulotomy. A cosmetic contact lens helped to resolve the symptoms. In cases of glare due to a large pupil, a painted cosmetic contact lens should be considered an option. J Cataract Refract Surg 2008; 34:1995–1996 Q 2008 ASCRS and ESCRS We present a case report of a patient who had glare fol- lowing pupilloplasty that was relieved by a painted cosmetic contact lens. CASE REPORT A 75-year-old man was referred to our unit by his general practitioner for what was described as excessive bright light entering the right eye, which had gradually worsened over the previous 6 months. In 2003, retinal detachment surgery with vitrectomy had been performed in the right eye. A cat- aract developed 2 months postoperatively and was subse- quently removed by phacoemulsification. However, a few months after the surgery, the patient realized that his right pupil was larger than the left and this was associated with intolerable glare. He was referred to a major eye center where purse-string pupilloplasty for an atonic pupil was performed. The symptoms resolved but in 2006, the glare started again and became progressively intolerable, with associated visual blurring. The patient was wearing a soft contact lens in the phakic left eye. The best corrected visual acuity (Snellen) was 6/48 in the right eye and 6/6 in the left eye. The exposed purse-string suture, with stromal atrophy and multiple areas of deficient tissue (iatrogenic polycoria), was in the iris margin of the right eye (Figure 1, top left). The posterior chamber intraocu- lar lens (IOL) was in situ, but there was also significant pos- terior capsule opacification. The retina was flat; the left eye was normal, as was the intraocular pressure in both eyes. A neodymium:YAG laser posterior capsulotomy was per- formed in the right eye and improved the visual acuity to 6/7.5, but the glare persisted. Arrangements were then made to fit the right eye with a specially designed contact lens. The specifications of the contact lens (Cantor and Nissel) were water content 74%, À8.50 À14.50 Â plano, and aperture diameter 4.5 mm. The contact lens had the same iris configuration as the left eye and was symmetrical to that eye (Figure 1, top right, bottom). Use of the contact lens resolved the ocular symptoms DISCUSSION Pupils that are dilated and nonreactive often cause ex- cessive glare since the aperture that controls the amount of light entering the eye becomes unregulated. If the opposite pupil is normal, the resulting pupil asymmetry may cause considerable cosmetic distress in some individuals. An iatrogenic atonic pupil can occur after surgical procedures such as cataract surgery and penetrating keratoplasty. 1–3 In our patient, the damage to the pupil occurred after phacoemulsification surgery; al- though he had purse-string pupilloplasty, further pro- gressive iris atrophy with resultant polycoria led to the recurrence of the ocular symptoms. Sutured pupillo- plasty is known to have late complications such as suture-related cheese wiring, atrophy of the iris stroma, loss of iris tissue, and loss of intrinsic tone of the dilator muscle with resultant tissue breakdown. The use of cosmetic colored contact lenses for med- ical reasons is not new. 4 These lenses are used for con- ditions such as congenital iris coloboma, cataract corneal scarring, posttraumatic iris damage, and albi- nism. However, other treatment modalities have to be considered in the light of factors such as acceptabil- ity, risks/potential complications, and reversibility of the procedure. Despite the stable suture in the pupil margin, because of the extent of the iris atrophy, our patient had to be fitted with a colored contact lens to Accepted for publication June 5, 2008. From the Department of Ophthalmology, Pilgrim Hospital, Boston, United Kingdom. No author has a financial or proprietary interest in any material or method mentioned. Corresponding author: Mr. Carpi Olali, Department of Ophthalmol- ogy, Pilgrim Hospital, Boston, PE 21 9QS, United Kingdom. E-mail: akikio771@hotmail.com. Q 2008 ASCRS and ESCRS Published by Elsevier Inc. 0886-3350/08/$dsee front matter 1995 doi:10.1016/j.jcrs.2008.06.040 CASE REPORT