Reverse pupillary block after implantation of a scleral-sutured posterior chamber intraocular lens: a retrospective, open study

Abstract

BackgroundTo report the clinical features of patients with reverse pupillary block (RPB) after scleral-sutured posterior chamber intraocular lens (PC IOL) implantation and biometric changes after laser peripheral iridotomy (LPI).MethodsEight patients attending our hospital’s ophthalmology outpatient clinic, who developed RPB after implantation of a scleral-sutured PC IOL due to subluxation of the crystalline lens or IOL, were investigated in this retrospective, observational study.ResultsPreoperative evaluations showed angle pigmentation in all cases and iridodonesis in 2 cases. Two subjects had used an α1A-adrenoceptor antagonist for benign prostatic hyperplasia. Pars plana or anterior partial vitrectomy was performed in all cases. All eyes showed an extremely deep anterior chamber, a concave iris configuration, and contact between the IOL optic and the iris at the pupillary margin. Pupil capture was detected in 2 cases. The mean (± SD) anterior chamber angle (ACA) was 89.91 ± 10.06°, and the anterior chamber depth (ACD) was 4.42 ± 0.16 mm before LPI. After LPI, the iris immediately became flat with a decreased ACA (51.70 ± 2.59°; P = 0.018) and ACD (4.14 ± 0.15 mm; P = 0.012). After LPI, the intraocular pressure decreased from 19.75 ± 3.77 mmHg to 15.63 ± 4.30 mmHg (P = 0.011), and the spherical equivalent decreased from -0.643 ± 0.385 D to − 0.875 ± 0.505 D (P = 0.016).ConclusionConcomitant vitrectomy, angle pigmentation, and iridodonesis may be risk factors for RPB after scleral-sutured PC IOL implantation. LPI is effective for relieving the RPB.

Evaluation of the Findings of Patients Who Underwent Sutureless Flanged Transconjunctival Intrascleral Intraocular Lens Implantation with or without Pars Plana Vitrectomy

“…In a 2018 study, Stem et al [ 3 ] reported the rate of increased IOP as 23%, which they attributed to RPB developing postoperatively, and recommended performing intraoperative prophylactic iridotomy in these patients. RPB is a rare finding after the scleral fixation of IOL, but it may result in pigment dispersion or iris capture and therefore might require treatment with postoperative laser peripheral iridotomy to prevent these negative effects [ 11 , 12 ]. In our study, RPB was not observed in any of the patients as a result of intraoperative prophylactic iridotomy being performed in all patients.…”

Repairing Cyclodialysis by Riveting: A Flanged Polypropylene Suture

“…It seems closely related to a history of trauma in view of existence of cyclodialysis and iridodonesis [ 10 ]. Iridodonesis is a risk factor for pupillary capture after suturing and intrascleral fixation of an IOL [ 11 ]. Repairing cyclodialysis is often technically difficult due to softness and flexibility of the iris and the narrow space between the cornea and lens.…”

Sutureless Intrascleral Posterior Chamber Intraocular Lens Fixation: Analysis of Clinical Outcomes and Postoperative Complications

“…After the surgery, the removal of the lens capsule and the lens zonular fibers with vitreous preserved a greater posterior chamber volume resulted in iris backward and more aqueous humor flowing into the anterior chamber [ 43 , 44 ] to push IOL up. And iris depigmentation due to the contact between IOL and the iris pigment epithelium might cause angle pigmentation, which slowed the aqueous humor flowing out from the anterior chamber [ 45 ]. We speculated these four reasons are responsible for pupillary capture.…”