Surgical peripheral iridectomy via a clear-cornea phacoemulsification incision for pupillary block following cataract surgery in acute angle closure.
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.
['Fang|Aiwu|A|', 'Wang|Peijuan|P|', 'He|Rui|R|', 'Qu|Jia|J|http://orcid.org/0000-0001-7368-427X']
D000328:Adult D000368:Aged D002387:Cataract Extraction D005260:Female D005500:Follow-Up Studies D015812:Glaucoma, Angle-Closure D006801:Humans D032801:Iridectomy D007498:Iris D019654:Lens Implantation, Intraocular D008297:Male D008875:Middle Aged D018918:Phacoemulsification D011183:Postoperative Complications D011681:Pupil Disorders D012189:Retrospective Studies D014792:Visual Acuity
Surgical peripheral iridectomy Phacoemulsification Pupillary block Acute angle closure