| 본문 : Purpose: To describe pupilloplasty as a surgical alternative to improve monocular diplopia due to corectopia. Case: A 25-year-old male presented with monocular diplopia in his left eye, started 1 year ago. The patient had undergone both eye cataract extraction surgery at 2 years of age due to congenital cataract in his both eye. At 9 years of age, he had undergone both eye secondary 3-piece intraocular lens(IOL) insertion and scleral fixation. Intraoperatively, adhesion between superior portion of iris and posterior capsule was seen in the left eye. Superior portion of posterior capsule was torn during synechiolysis and other part of the capsule remained intact. The IOL was inserted successfully at sulcus in the left eye. Best corrected visual acuity was 20/80 in both eyes at the last ophthalmologic examination, done at 21 years of age. Further follow-up was lost. Four years later, the patient revisited the clinic with the complaints of headache and monocular diplopia when gazing with his left eye. Other work-ups including brain MRI and CSF tapping were normal. The patient was referred to strabismus clinic with 8~10 prism diopter esotropia, and with fusion training, diplopia was improved. His headache was improved with medication under the impression of migraine at the department of neurology. However, his left eye monocular diplopia at upgaze was remained. His best corrected visual acuity was 20/100 in right eye, 20/80 in left eye. His binocular visual acuity was 20/40 due to latent nystagmus. Left eye corectopia was seen at superior portion, peaking to 10 o/c, and IOL margin was seen through the irregular portion. The symptom was improved with pin-hole glass on the left eye. At first, YAG laser was done at iris to make the shape of the pupil to be more round and to contract the iris over the superior IOL margin. After laser, the shape of the pupil was more round, but IOL margin still seen through the pupil. His symptom was not improved until 2 months after the laser. Pupilloplasty was done with a knot of 10-0 prolene by Sipser sliding knot procedure in the operating room to cover the superior IOL margin with iris. The patient was satisfied at 1 week and 1 month after the surgery, without any monocular diplopia in his left eye. Conclusion: Pupilloplasty can be a satisfactory surgical technique to improve monocular diplopia in the patient with corectopia. |