Pupilloplasty: The Art of Renewing Eye Pupil

Introduction

The pupil is the black, circular opening present at the center of the iris, whereas the iris is the colored portion of the eye. The black-colored appearance of the pupil is because the light assessing the eye gets absorbed by the light-sensitive tissue layer present at the back of the eye called the retina. The size of the pupil can change as a response to various light conditions and emotions. Generally, the pupil constricts in bright light and dilates in dim light. The pupil's size, position, and responsiveness can be changed under physiological and pathological conditions.

What Is Pupilloplasty?

Pupilloplasty is a surgical intervention that is employed to repair and reshape the pupil. This procedure is generally performed to amend the congenital and acquired abnormalities of the pupil, like misshapen pupils and irregularly sized pupils. In certain cases, this procedure improves the esthetic appearance of the eye while, in other cases, it addresses the rudimentary issues associated with the size and shape of the pupil like anisocoria. This is a specialized and delicate eye surgery carried out by ophthalmic surgeons who have expertise in ocular plastic and reconstructive interventions.

What Are the Techniques of Pupilloplasty?

Various techniques are employed in pupilloplasty according to the distinctive requirements of the individual and the type of pupil abnormality.

Here are some common pupilloplasty techniques.

• Iris Reconstruction: This is applied in damaged pupils due to disease or injury. Here, the healthcare professionals reconstruct the damaged iris tissue by means of flaps or grafts taken from the same or another eye.

• Iris Suturing: This technique incorporates suturing of the iris for reshaping the pupil or modifying its actual size. This is indicated in patients requiring correction of the shape of the pupil. Moreover, this approach is effective in constructing a smaller pupil.

• Iris Implants: The doctors recommend artificial iris implants for significant and severe iris damage and congenital absence of iris. This technique helps improve the appearance of the pupil, enhancing light sensitivity.

• Iris Prosthesis: Iris prosthesis is similar to iris artificial implants. Here, it involves the placement of a custom-made prosthetic iris according to the patient's needs and pupil abnormalities. This also helps enhance the aesthetic appearance and light sensitivity of the pupil.

• Iris Sphincterotomy: A small incision is made in the iris sphincter muscles (also called pupillary sphincter) to widen the pupil and improve access to light. This approach is indicated in the case of small and irregular pupils.

• Pupil Ring: This includes implanting a small ring-shaped device into the pupil. This helps maintain the pupil's size, position, and shape.

• Pupil Cerclage: Pupil cerclage is a pupilloplasty where the pupil is encircled through a loop-like suture. This particular technique is used to regulate the size and shape of the pupil.

• Pupilloplasty With Surgery: Pupilloplasty can sometimes be used in conjunction with cataract surgery. This addresses both pupil and cataract abnormalities eventually.

What Are the Applications of Pupilloplasty?

Pupilloplasty surgery can be applied in various aspects, including functional and cosmetic fields. The indications for pupilloplasty include the following.

Eye Health Conditions:

People with symptomatic iris defects can benefit from surgical intervention. The symptoms associated with the iris defect include glares, Diplopia (double vision), and shadow images. The iris defect occurs due to iris lesion removal, direct trauma causing pupil irregularities, and complicated intraocular surgery.

Decentered pupils can be corrected and re-centered with pupilloplasty. The laser pupilloplasty is particularly indicated in the case of a decentered pupil associated with an implanted intraocular lens.

Lens Implantations:

This procedure can be done to provide essential support for people having iris-claw intraocular lens implantation as a preference when there is no adequate capsular function to implant the intraocular lens.

Preventing Complications:

Pupilloplasty can be performed to prevent certain postoperative complications in penetrating keratoplasty. In several cases of floppy iris, there can be a chance of adherence of the iris to the graft's peripheral edge, resulting in peripheral anterior synechiae. Synechiae adhesions could increase the possibility of total graft failure or angle closure. Pupilloplasty can help tighten the iris preventing such synechiae adhesions.

Cosmetic Concern:

Pupilloplasty is performed for cosmetic purposes in rare instances. Cosmetic pupilloplasty is considered for large colobomas in the colored iris, contributing to functional and aesthetic repair.

Relieves Angle Closure:

Single pass four pupilloplasty can help break the angle closure and the concerned effects in case of the post-trauma condition, plateau iris syndrome (a type of primary angle closure glaucoma), and Urrets- Zavalia syndrome (fixed and dilated pupil).

What Are the Contraindications of Pupilloplasty?

The contraindications for pupilloplasty include the following:

• Phakic eye with a clear lens, whereas phakic eye refers to the intraocular lens implanted into the eye even without eliminating the natural eye lens. Pupilloplasty in the phakic eye can increase the risk of lens contact and cataract formation.

• Pupilloplasty is also contraindicated in atrophic iris because of the risk of an iridodialysis (tearing away or localized separation of the iris from its contact with the ciliary body) and potential iris damage.

What Are the Complications Associated With Pupilloplasty?

Pupilloplasty is considered a safe and effective intervention with preventive measures. It can result in certain complications in some cases.

The possible complications of pupilloplasty include the following:

• Iritis, swelling, and inflammatory condition of the iris.

• Iris dialysis.

• Cataract, clouding of the normal and clear lens of the eye.

• Hyphema is a condition known for blood accumulation in the eye's front chamber.

• Impaired vision.

• Night vision discrepancies.

• Retinal detachment is a serious eye disorder where the retina gets detached from its actual position.

Conclusion:

Pupilloplasty is a surgical intervention that involves repairing and reconstructing the pupil of the eye. This procedure generally addresses problems with the pupil's size, shape, and position. However, it is essential to note that the preference for pupilloplasty depends on a number of determinants, including the underlying health condition, eye health, and pupil status. The ophthalmologists diagnose the condition and offer personalized recommendations tailored for each individual, considering their needs and requirements.