Surgical peripheral iridectomy via a clear-cornea phacoemulsification incision for pupillary block following cataract surgery in acute angle closure.
|Abstract||To describe a technique of surgical peripheral iridectomy via a clear-cornea tunnel incision to prevent or treat pupillary block following phacoemulsification.|
The efficacy and safety of combined phacoemulsification, intraocular lens implantation, and limited goniosynechialysis, followed by diode laser peripheral iridoplasty, in the treatment of cataract and chronic angle-closure glaucoma.
|Journal Title||bmc ophthalmology|
|Publication Year Start||2018-01-01|
PMID- 29776352 OWN - NLM STAT- MEDLINE DCOM- 20180525 LR - 20180525 IS - 1471-2415 (Electronic) IS - 1471-2415 (Linking) VI - 18 IP - 1 DP - 2018 May 18 TI - Surgical peripheral iridectomy via a clear-cornea phacoemulsification incision for pupillary block following cataract surgery in acute angle closure. PG - 120 LID - 10.1186/s12886-018-0786-2 [doi] AB - BACKGROUND: To describe a technique of surgical peripheral iridectomy via a clear-cornea tunnel incision to prevent or treat pupillary block following phacoemulsification. METHODS: Description of technique and retrospective description results in 20 eyes of 20 patients with acute angle closure with coexisting visually significant cataract undergoing phacoemulsification considered at risk of postoperative papillary block as well as two pseudo-phakic eyes with acute postoperative pupillary-block. Following phacoemulsification and insertion of an intraocular lens, a needle with a bent tip was inserted behind the iris through the corneal tunnel incision. A blunt iris repositor was introduced through the paracentesis and placed above the iris to exert posterior pressure and create a puncture. The size of the puncture was enlarged using scissors. For postoperative pupillary block the same technique was carried out through the existing incisions created for phacoemulsification. RESULTS: Peripheral iridectomy was successfully created in all 22 eyes. At a mean follow-up of 18.77 +/- 9.72 months, none of the iridectomies closed or required enlargement. Two eyes had mild intraoperative bleeding and one eye a small Descemet's detachment that did not require intervention. No clinically significant complications were observed. Visual acuity and IOP improved or was maintained in all patients. The incidence of pupillary block in our hospital was 0.09% overall, 0.6% in diabetics and 3.5% in those with diabetic retinopathy. CONCLUSIONS: This technique of peripheral iridectomy via the cornea tunnel incision can be safely used during phacoemulsification in eyes at high risk of pupillary block or in the treatment of acute postoperative pupillary-block after cataract surgery. The technique is likely to be especially useful in brown iris, or if a laser is not available. FAU - Fang, Aiwu AU - Fang A AD - Wenzhou Medical University Eye Hospital, Wenzhou, 325027, China. FAU - Wang, Peijuan AU - Wang P AD - Wenzhou Medical University Eye Hospital, Wenzhou, 325027, China. FAU - He, Rui AU - He R AD - Wenzhou Medical University Eye Hospital, Wenzhou, 325027, China. FAU - Qu, Jia AU - Qu J AUID- ORCID: http://orcid.org/0000-0001-7368-427X AD - Wenzhou Medical University Eye Hospital, Wenzhou, 325027, China. [email protected] LA - eng PT - Journal Article DEP - 20180518 PL - England TA - BMC Ophthalmol JT - BMC ophthalmology JID - 100967802 SB - IM MH - Adult MH - Aged MH - Cataract Extraction/*adverse effects MH - Female MH - Follow-Up Studies MH - Glaucoma, Angle-Closure/surgery MH - Humans MH - Iridectomy/*methods MH - Iris/surgery MH - Lens Implantation, Intraocular MH - Male MH - Middle Aged MH - Phacoemulsification/*methods MH - Postoperative Complications/*surgery MH - Pupil Disorders/*surgery MH - Retrospective Studies MH - Visual Acuity PMC - PMC5960131 OTO - NOTNLM OT - Acute angle closure OT - Phacoemulsification OT - Pupillary block OT - Surgical peripheral iridectomy EDAT- 2018/05/20 06:00 MHDA- 2018/05/26 06:00 CRDT- 2018/05/20 06:00 PHST- 2017/03/26 00:00 [received] PHST- 2018/05/09 00:00 [accepted] PHST- 2018/05/20 06:00 [entrez] PHST- 2018/05/20 06:00 [pubmed] PHST- 2018/05/26 06:00 [medline] AID - 10.1186/s12886-018-0786-2 [doi] AID - 10.1186/s12886-018-0786-2 [pii] PST - epublish SO - BMC Ophthalmol. 2018 May 18;18(1):120. doi: 10.1186/s12886-018-0786-2.