Fang Aiwu, Wang Peijuan, He Rui, Qu Jia
Wenzhou Medical University Eye Hospital, Wenzhou, 325027, China.
BMC Ophthalmol. 2018 May 18;18(1):120. doi: 10.1186/s12886-018-0786-2.
To describe a technique of surgical peripheral iridectomy via a clear-cornea tunnel incision to prevent or treat pupillary block following phacoemulsification.
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.
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.
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.
描述一种经透明角膜隧道切口进行手术周边虹膜切除术的技术，以预防或治疗白内障超声乳化术后的瞳孔阻滞。
描述该技术并回顾性描述20例急性闭角型青光眼合并有临床意义的白内障且被认为有术后瞳孔阻滞风险的患者的20只眼，以及2只白内障超声乳化术后急性瞳孔阻滞的人工晶状体眼的结果。白内障超声乳化及人工晶状体植入术后，将尖端弯曲的针经角膜隧道切口插入虹膜后方。钝头虹膜整复器经侧切口插入并置于虹膜上方以施加后压力并形成穿刺口。用剪刀扩大穿刺口的大小。对于术后瞳孔阻滞，通过白内障超声乳化术所做的现有切口采用相同技术。
所有22只眼均成功完成周边虹膜切除术。平均随访18.77±9.72个月，所有虹膜切除术均未闭合或需要扩大。2只眼术中出现轻度出血，1只眼有小的后弹力层脱离，无需干预。未观察到具有临床意义的并发症。所有患者的视力和眼压均改善或维持稳定。我院瞳孔阻滞的总体发生率为0.09%，糖尿病患者为0.6%，糖尿病视网膜病变患者为3.5%。
这种经角膜隧道切口的周边虹膜切除术技术可安全用于瞳孔阻滞高危眼中的白内障超声乳化术期间，或用于治疗白内障手术后的急性术后瞳孔阻滞。该技术可能对褐色虹膜眼特别有用，或在没有激光设备时尤其有用。
