Peripheral Iridectomy in Intrascleral Intraocular Lens Fixation: Preventing Reverse Pupillary Block

To compare clinical outcomes, reverse pupillary block (RPB) findings, and anterior segment parameters in patients with and without intraoperative peripheral iridectomy during sutureless flattened flange intrascleral intraocular lens (IOL) fixation.

Retrospective comparative case series.

This study included 94 eyes of 82 patients who underwent IOL explantation due to vitreous-dislocated IOL at our clinic between March 2020 and September 2023, followed by flattened haptic-tipped IOL intrascleral fixation combined with pars plana vitrectomy. The patients were divided into two groups: Group 1 (n = 54) underwent peripheral iridectomy during surgery, while Group 2 (n = 40) did not undergo surgical peripheral iridectomy. Anterior chamber depth (ACD), anterior chamber angle (ACA), and white-to-white distance were measured with Scheimpflug imaging.

Visual outcomes, ACD, ACA, spherical equivalent (SE), intraocular pressure (IOP), complications, and secondary interventions were evaluated.

There was no significant difference between the two groups preoperatively in terms of IOP, ACD, ACA, white-to-white distance, and axial length (P > .05). Postoperatively, the mean ACD was significantly less in Group 1 (3.79 ± 0.67 mm) than in Group 2 (4.11 ± 0.75 mm) (P = .03). Postoperative IOP was 15.51 ± 2.48 mm Hg in group 1 and 18.20 ± 4.51 mm Hg in group 2 (P < .001). The postoperative ACA was statistically significantly shallower in Group 1 (41.72 ± 3.47 degrees) than in Group 2 (52.45 ± 17.93 degrees) (P < .001). Postoperatively, RPB developed in 10 eyes (25.0%) in Group 2, while it was not observed in any patient in Group 1 (P < .001). In Group 2, pupillary capture developed in 4 cases (10%) in addition to RPB. Laser peripheral iridotomy (LPI) was performed in cases with RPB. After LPI, mean IOP, mean ACA, and ACD also decreased significantly (P < .001).

Intraoperative peripheral iridectomy during scleral fixation surgery combined with pars plana vitrectomy leads to significantly less RPB, a more stable anterior chamber, and fewer complications. LPI was very useful in managing RPB that developed in the postoperative period.