Clinical manifestations of reverse pupillary block after scleral‐fixated intraocular lens implantation: Pre‐ and post‐laser peripheral iridotomy

Abstract

PurposeTo present the clinical features and intraocular pressure (IOP) changes of patients with reverse pupillary block (RPB) after scleral fixated intraocular lens (IOL) implantation treated with laser peripheral iridotomy (LPI).MethodsA chart review of patients presenting with elevated IOP and RPB after sclera fixated IOL implantation was carried out. LPI was performed in 5 eyes of total 6 eyes included in the study. Ultrasound biomicroscopy (UBM) and Goldmann applanation tonometry (GAT) was also performed before and after laser treatment.ResultsFive men who underwent LPI at a mean of 38.2 months (range 9 to 75 months) after scleral‐fixated PC IOL implantation were included. Two patients had history of retinal detachment, one subject had a history of trauma, and one patient was previously diagnosed with open angle glaucoma. Angle recession was not observed in all cases. The mean axial length was 24.24 ± 1.14 mm (range 22.86 to 25.44). Scleral fixated IOL implantation with pars plana vitrectomy was performed in all cases. All eyes showed extremely deep anterior chamber with pigment (trace to 1 + ), a concave iris configuration and angle pigmentation before LPI. On UBM, all eyes showed RPB. After LPI, RPB was resolved on slit lamp examination and UBM in all cases. IOP decreased within normal range (from 29.00 ± 12.37 to 13.40 ± 2.88 mmHg, p = 0.043) temporarily, but IOP elevated again (to 30.20 ± 15.39 mmHg, p = 0.068) few weeks after LPI and all patients needed IOP lowering medications.ConclusionsLPI is effective for relieving the RPB. But, in some patients, IOP was still elevated and IOP lowering eye drops were needed persistently. Even though RPB is reloved, regular check up of IOP after LPI is recommended. Also it is necessary to consider the possibility of previously decreased TM function.