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

Seung Pil Bang,Jong Hwa Jun,Choun-Ki Joo

doi:10.1186/s12886-017-0427-1

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.

Highlights

To 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)
Reverse pupillary block is rare in scleral-sutured PC IOL, but extreme posterior bowing of the iris can lead to repetitive pupil capture, pigment dispersion due to
Angle pigmentation was observed in all cases by gonioscopy, and manifested as mild pigmentation in 5 eyes and moderate pigmentation in 3 eyes

Summary

Introduction

To 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). Contrary to the characteristic posterior-to-anterior rush of fluid immediately after laser peripheral iridectomy (LPI) in traditional relative pupillary block, the breakthrough fluid rush in RPB is in the reverse direction, indicating that differential pressures exist between the classically described in phakic patients, RPB had been reported in other clinical situations, including intraocular lens (IOL) implantation in the ciliary sulcus [3], ‘in-the-bag’ IOL implantation [8, 9], and scleral-sutured posterior chamber (PC) IOL implantation [10, 11]. Reverse pupillary block is rare in scleral-sutured PC IOL, but extreme posterior bowing of the iris can lead to repetitive pupil capture, pigment dispersion due to Anterior segment optical coherence tomography, recently developed and widely used for diagnostic purposes, and Scheimpflug imaging have been helpful in detecting and understanding the mechanism of RPB in a number of clinical cases [9,10,11].

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