Risk factors for occurrence of reverse pupillary block after intraocular lens fixation surgery

To identify risk factors for reverse pupillary block (RPB) by retrospectively analyzing anterior segment optical coherence tomography (AS-OCT) images after intraocular lens (IOL) fixation surgery.

Department of Ophthalmology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan.

Retrospective observation study.

60 eyes that underwent scleral-sutured or intrascleral IOL fixation at our institution, from October 2019 to August 2023. Of these, 54 eyes did not develop RPB (RPB- group), whereas 6 eyes did (RPB+ group). Within 1 month postoperatively, AS-OCT was used to measure iris length, IOL-iris distance, anterior chamber depth (ACA), anterior chamber width, angle-to-angle distance, steep and flat meridian keratometry, and central corneal thickness. These parameters were compared between the 2 groups. The significant differences parameters were further analyzed using multivariate nominal logistic regression to calculate odds ratios for RPB development.

The RPB (+) group showed significantly better postoperative logMAR corrected distance visual acuity compared with the RPB (-) group ( P = .04). No significant differences were observed in intraocular pressure, axial length, or history of ocular or systemic conditions. AS-OCT analysis revealed that iris length was significantly greater in the RPB (+) group ( P = .01), while no significant differences were found in IOL-iris distance, ACA, or other parameters. Multivariate nominal logistic regression identified iris length as a significant risk factor for RPB, with an odds ratio of 32.9 ( P < .01).

Longer iris length may be associated with an increased risk of RPB after intraocular lens fixation surgery.