Visual and optical outcomes of pupilloplasty in glued intrascleral intraocular lens eyes with irregular mydriatic pupils

PURPOSE: The purpose of this paper is to evaluate the impact of pupilloplasty on visual outcomes and optical quality in eyes with irregular, persistently dilated pupils following glued intrascleral posterior chamber intraocular lens (IOL) implantation. DESIGN: Retrospective observational study. METHODS: Fourteen eyes of fourteen patients presenting with persistent mydriasis and visual symptoms after glued intrascleral IOL fixation were analyzed. Single-pass four-throw pupilloplasty was performed in all cases except one, which required trifold pupilloplasty. Preoperative and 1-week postoperative evaluations included best-corrected visual acuity (BCVA), mesopic pupil diameter, and corneal wavefront parameters-optical path difference root mean square (OPD RMS), higher-order RMS (HO RMS), astigmatism RMS, coma, spherical aberration, and point spread function (PSF) Strehl ratio-measured using the Sirius Scheimpflug-Placido system. Subjective visual satisfaction was also assessed. Outcomes were assessed at 1 week postoperatively, representing early anatomical and optical stabilization following pupillary reconstruction. RESULTS: Mean BCVA improved significantly from 0.62 ± 0.31 to 0.23 ± 0.10 logMAR ( P < 0.001). Mesopic pupil size reduced from 6.18 ± 0.88 to 2.59 ± 0.21 mm ( P < 0.001). Significant postoperative reductions were observed in OPD RMS, HO RMS, astigmatism RMS, coma, and spherical aberration (all P ≤ 0.03). The PSF Strehl ratio increased more than threefold ( P < 0.001). All patients reported symptomatic improvement, with 85.7% rating postoperative vision as very good or excellent. No intraoperative or postoperative complications were noted. CONCLUSION: Pupilloplasty effectively reconstructs a near-physiologic pupil and leads to marked early improvement in visual acuity and optical quality in eyes with irregular mydriasis after glued intrascleral IOL implantation; however, longer follow-up studies are required to confirm long-term stability.