Peripheral Iridectomy in Intrascleral Intraocular Lens Fixation: Preventing Reverse Pupillary Block

IF 4.1 1区医学 Q1 OPHTHALMOLOGY American Journal of Ophthalmology Pub Date : 2024-10-11 DOI:10.1016/j.ajo.2024.10.005

Fikret Ucar , Muhammed Sagdic

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Abstract

Purpose

To compare clinical outcomes, reverse pupillary block (RPB) findings, and anterior segment parameters in patients with and without intraoperative peripheral iridectomy during sutureless flattened flange intrascleral intraocular lens (IOL) fixation.

Design

Retrospective comparative case series.

Participants

This study included 94 eyes of 82 patients who underwent IOL explantation due to vitreous-dislocated IOL at our clinic between March 2020 and September 2023, followed by flattened haptic-tipped IOL intrascleral fixation combined with pars plana vitrectomy. The patients were divided into two groups: Group 1 (n = 54) underwent peripheral iridectomy during surgery, while Group 2 (n = 40) did not undergo surgical peripheral iridectomy. Anterior chamber depth (ACD), anterior chamber angle (ACA), and white-to-white distance were measured with Scheimpflug imaging.

Main outcomes

Visual outcomes, ACD, ACA, spherical equivalent (SE), intraocular pressure (IOP), complications, and secondary interventions were evaluated.

Results

There was no significant difference between the two groups preoperatively in terms of IOP, ACD, ACA, white-to-white distance, and axial length (P > .05). Postoperatively, the mean ACD was significantly less in Group 1 (3.79 ± 0.67 mm) than in Group 2 (4.11 ± 0.75 mm) (P = .03). Postoperative IOP was 15.51 ± 2.48 mm Hg in group 1 and 18.20 ± 4.51 mm Hg in group 2 (P < .001). The postoperative ACA was statistically significantly shallower in Group 1 (41.72 ± 3.47 degrees) than in Group 2 (52.45 ± 17.93 degrees) (P < .001). Postoperatively, RPB developed in 10 eyes (25.0%) in Group 2, while it was not observed in any patient in Group 1 (P < .001). In Group 2, pupillary capture developed in 4 cases (10%) in addition to RPB. Laser peripheral iridotomy (LPI) was performed in cases with RPB. After LPI, mean IOP, mean ACA, and ACD also decreased significantly (P < .001).

Conclusions

Intraoperative peripheral iridectomy during scleral fixation surgery combined with pars plana vitrectomy leads to significantly less RPB, a more stable anterior chamber, and fewer complications. LPI was very useful in managing RPB that developed in the postoperative period.

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巩膜内眼内透镜固定中的周边虹膜切除术：防止瞳孔反向阻滞。

目的比较在无缝线扁平凸缘巩膜内人工晶体（IOL）固定术中进行和未进行术中周边虹膜切除术的患者的临床结果、反向瞳孔阻滞（RPB）结果和眼前节参数。参与者本研究纳入了 2020 年 3 月至 2023 年 9 月期间在我院因玻璃体脱位而接受 IOL 取出术的 82 例患者中的 94 只眼睛，这些患者均接受了扁平触点 IOL 巩膜内固定术，并进行了玻璃体旁切除术（PPV）。患者分为两组：第一组（54 人）在手术过程中进行了周边虹膜切除术，而第二组（40 人）没有进行周边虹膜切除术。通过 Scheimpflug 成像测量前房深度（ACD）、前房角（ACA）和白-白（WTW）距离。主要结果评估视觉结果、ACD、ACA、球面等值（SE）、眼压（IOP）、并发症和二次干预。术后，第一组的平均 ACD（3.79 ± 0.67 mm）明显低于第二组（4.11 ± 0.75 mm）（P = 0.03）。第一组术后眼压为 15.51 ± 2.48 mmHg，第二组为 18.20 ± 4.51 mmHg（p < 0.001）。据统计，术后 ACA 第一组（41.72 ± 3.47 度）明显比第二组（52.45 ± 17.93 度）浅（p < 0.001）。术后，第 2 组有 10 只眼睛（25.0%）出现了 RPB，而第 1 组没有发现任何患者出现 RPB（p < 0.001）。在第 2 组中，除 RPB 外，还有 4 例（10%）患者出现了瞳孔捕获。对有 RPB 的病例进行了激光周边虹膜切开术。结论在巩膜固定手术中结合 PPV 进行术中周边虹膜切除可显著减少 RPB，使前房更稳定，并减少并发症。激光周边虹膜切开术对于处理术后出现的 RPB 非常有用。

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来源期刊

American Journal of Ophthalmology 医学-眼科学

CiteScore

9.20

自引率

7.10%

发文量

406

审稿时长

36 days

期刊介绍： The American Journal of Ophthalmology is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and visual science specialists describing clinical investigations, clinical observations, and clinically relevant laboratory investigations. Published monthly since 1884, the full text of the American Journal of Ophthalmology and supplementary material are also presented online at www.AJO.com and on ScienceDirect. The American Journal of Ophthalmology publishes Full-Length Articles, Perspectives, Editorials, Correspondences, Books Reports and Announcements. Brief Reports and Case Reports are no longer published. We recommend submitting Brief Reports and Case Reports to our companion publication, the American Journal of Ophthalmology Case Reports. Manuscripts are accepted with the understanding that they have not been and will not be published elsewhere substantially in any format, and that there are no ethical problems with the content or data collection. Authors may be requested to produce the data upon which the manuscript is based and to answer expeditiously any questions about the manuscript or its authors.