Intraoperative reverse pupillary block during femtosecond laser-assisted cataract surgery in a patient with phacomorphic angle closure.

UNLABELLED: We report a patient with phacomorphic angle closure having femtosecond laser-assisted cataract surgery. A staged procedure was followed to achieve mydriasis and deepen the anterior chamber with bisulfate-free epinephrine (epi-Shugarcaine) and an ophthalmic viscosurgical device (OVD) prior to the femtosecond procedure. After the femtosecond laser was docked, the patient complained of discomfort in her eye and intraoperative optical coherence tomography imaging revealed a reverse pupillary block configuration. Software modifications were required to complete the procedure, following which partial OVD removal and anterior tenting of the pupil margin relieved the reverse pupillary block. In the fellow eye, intracameral bisulfate-free epinephrine alone was injected above and below the iris plane for intraoperative mydriasis and to deepen the anterior chamber, which prevented a reverse pupillary block. FINANCIAL DISCLOSURE: Neither author has a financial or proprietary interest in any material or method mentioned.