In our enlightened age of small incision, closed-system anterior segment surgery, we have increased surgical control over the intraocular environment and have developed the skills for more sophisticated iris repair. Simultaneously, we are more attentive to glare and photophobic complaints from our cataract and refractive surgery patients. The confluence of increased awareness and surgical abilities set the stage for the new epoch in iris surgery. An abnormal iris can be acquired or congenital. Congenital etiologies include aniridia, Reiger's anomaly and other anterior segment dysgeneses.
Abnormal pupils affect patients in several ways, including photophobia and glare.
These patients often describe discomfort or difficulty in brightly lit areas, such as supermarkets, or on sunny days. Typically, they report that sunglasses do not alleviate their symptoms either outside or indoors. Rarely, an irregular pupil may induce an undesired refractive effect. Since the visual axis usually goes through the geometric center of the pupil, the visual axis-corneal intercept may be abnormally placed through an area of irregular corneal topography. An abnormal pupil may also have deleterious psychosocial effects.