title: Surgical complications caused by inaccurate scotopic preoperative pupillary measurement in cataract and lasik surgery: case report and review of the literature.
abstract: Accurate scotopic preoperative pupillary measurements in both cataract and lasik surgery cases are critical to avoid in individuals with naturally briskly dilating pupils under scotopic conditions postoperative visual disability related to low light reflections, disabling illuminance, glare disability, halos, starbursts, and diplopia with night vision. Both edge reflections of the pseudophakos implant in cataract surgery and the ablated corneal margin in lasik surgery can contribute to serious visual disability in patients who have larger scotopic pupils exposing the edge of the implanted lens or the surgical optical zone of the ablated cornea to the entrance pupil. A case is presented in which cataract surgery was performed initially with a 5.5-mm-diameter optic lens in one eye and later a 7.0-mm-diameter optic lens in the other eye. Because of a naturally briskly dilating pupil of 7.0 mm, the eye with the smaller implant experienced significant night vision difficulties because of edge reflections of the exposed implant. The other eye in the very same patient with the larger lens implant was asymptomatic. This case underscores the importance of accurate preoperative pupillary measurements under scotopic conditions to avoid this preventable disabling surgical complication in both cataract and lasik cases.
authors.affiliation: Department of Ophthalmology, Northwestern University Medical School, Chicago, Illinois, USA.
authors.forename: John H
authors.initials: JH
authors.lastname: Fournier
authors.forename: Mark I
authors.initials: MI
authors.lastname: Golden
mesh_terms: D002387:Cataract Extraction / Q000009:adverse effects*; D015350:Contrast Sensitivity; D006801:Humans; D020731:Keratomileusis, Laser In Situ; D007910:Lenses, Intraocular; D008297:Male; D008875:Middle Aged; D017755:Prosthesis Fitting / Q000379:methods; D014786:Vision Disorders / Q000209:etiology* / Q000517:prevention & control