January consultation # 7

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My first observation is that the pupil size should have been discussed with this patient preoperatively. Whether pupil size was a contraindication to any refractive approach with a 5.0 mm diameter, such as with the toric pIOL used, should also have been considered.

On the other hand, in my experience and that of others, pupil size is not usually the main reason for glare and halos after refractive procedures. In this case, I would first ask the patient to wear spectacles with the appropriate correction for some weeks. There is no doubt that visual acuity will improve, and the glare and halos might, too. If this were the case, and taking into account the topographic evaluation, I would suggest laser refractive surgery to correct the residual refractive error.

If despite the visual improvement, the glare and halos persist and the pIOLs are properly centered, I would recommend explanting the pIOLs. A positive response to the topical use of Alphagan has been published; however, in my experience, it has not been very useful. On the other hand, I would never recommend continuous use of miotic agents such as pilocarpine.