Risk factors for occurrence of reverse pupillary block after intraocular lens fixation surgery.

PURPOSE: To identify risk factors for reverse pupillary block (RPB) by retrospectively analyzing anterior segment optical coherence tomography (AS-OCT) images after intraocular lens (IOL) fixation surgery.

SETTING

Department of Ophthalmology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan.

DESIGN

Retrospective observation study.

METHODS

60 eyes that underwent scleral-sutured or intrascleral IOL fixation at our institution, from October 2019 to August 2023. Of these, 54 eyes did not develop RPB (RPB- group), whereas 6 eyes did (RPB+ group). Within 1 month postoperatively, AS-OCT was used to measure iris length, IOL-iris distance, anterior chamber depth (ACA), anterior chamber width, angle-to-angle distance, steep and flat meridian keratometry, and central corneal thickness. These parameters were compared between the 2 groups. The significant differences parameters were further analyzed using multivariate nominal logistic regression to calculate odds ratios for RPB development.

RESULTS

The RPB (+) group showed significantly better postoperative logMAR corrected distance visual acuity compared with the RPB (-) group ( P = .04). No significant differences were observed in intraocular pressure, axial length, or history of ocular or systemic conditions. AS-OCT analysis revealed that iris length was significantly greater in the RPB (+) group ( P = .01), while no significant differences were found in IOL-iris distance, ACA, or other parameters. Multivariate nominal logistic regression identified iris length as a significant risk factor for RPB, with an odds ratio of 32.9 ( P < .01).

CONCLUSIONS

Longer iris length may be associated with an increased risk of RPB after intraocular lens fixation surgery.