Atonic pupils after uncomplicated phacoemulsification and intraocular lens implantation

An atonic pupil, defined as a dilated pupil of unknown origin, is a rare postoperative complication of ophthalmic surgery. We studied the incidence of atonic pupils after uncomplicated phacoemulsification and intraocular lens implantation (PEA+IOL) and analyzed the clinical profiles of four cases of atonic pupil.

We surveyed 54 ophthalmologists in 28 hospitals to determine their clinical experience with atonic pupils after uncomplicated PEA+IOL procedures and the total number of PEA+IOL procedures performed. The medical charts of four cases of atonic pupils were reviewed retrospectively.

The response rate was 77.8% (42/54). Surgeon experience with PEA+IOL ranged from 1 to 15 years. Three of 42 ophthalmologists (7.1%) had had at least one case of an atonic pupil after uncomplicated PEA+IOL. Four of 58,887 cases (incidence, 0.0067%) developed an atonic pupil after uncomplicated PEA+IOL. All four cases had glare and three cases were treated with an iris contact lens, an iris diaphragm ring, and photochromic lenses. There were no specific common characteristics among the cases beyond ocular pain and headache perioperatively.

The incidence of atonic pupil was very low. Most patients with an atonic pupil have some symptoms that require treatment.