blown pupil, traumatic mydriasis

[karp989]

I'm 23 years old. had eye trauma two years ago. only left eye. Had an iol in place, but it left my eyes unbalanced. Contacts dont seem to work well. I also have a huge pupil. dr. recommends  doing piggyback with iris suture, what do you guys thing about this procedure. My right eye still has a clear lens, i dont want to touch it with surgery or laser or prk, since i have thin corneas. Keratoconous.
after cataract surgery                                   -4.25 +3.75x110(od) plus prescription
                                                                         +.50+.75x090    (os) plus prescription

[John C Hagan III, MD, FACS, FAAO]

No I have never done a procedure for a blown pupil, have repaired several torn due to truma and previous "old time" surgery (sector iridectomy) done long ago. The thing about this is that it's very unusual surgery and it is important to pick a surgeon that specializes in post operative problems and that has does the piggy-back and iris repair before.

Given your situation most of my patients have oppted for surface PRK (eximer laser on surface of eye with no surgery to balance RX. No problem for most thin corneas. Obviously if you do have K-conus that is not an option.

The closest case I have managed had PRK on the eye without cataract to balance the RX then was fittied with a special contact lens that has an iris and pupil on it. I forget the name of this contact but it worked well.

JCH MD

[karp989]

Oh i forgot to thank you for your previous response Dr Hagan. In your experience have you ever done the iris suture procedure, and what you thing about piggybacking the lens with the staar silicone lens. in the hands of an experienced surgeon.. Once again thank you for your limited time given up to help those of us on this side of the screen.

[karp989]

I understand what you are trying to say Dr. The thing is that right now is not normal, is always about 10 mm dilated all the time. it doesnt constrict . and always makes my vision blurry all the time. Two doctors have seen my eyes already. Dr. John Davison and Dr. Oleynikov in CAlifornia, they both mentioned that this procedure is an option. From the drs. perspective, even if the iol is clear theres always going to be more light spreading trough a bigger area on the cornea, due to the big pupil being open all the time. causing my blurry vision.

[John C Hagan III, MD, FACS, FAAO]

I would get 2-3 different opinions before you jump on the surgery table. If the pupil is made small with an iris suture it will not dilate or constrict and not be normal just smaller all the time.

JCH MD