American journal of ophthalmology · 2024
Peripheral Iridectomy in Intrascleral Intraocular Lens Fixation: Preventing Reverse Pupillary Block.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Ucar Fikret, Sagdic Muhammed
Аннотация
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.
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.