|Year : 1982 | Volume
| Issue : 4 | Page : 289-290
Photocoreoplasty for updrawn pupil and S. T. Fernandez
Deptt. of Ophthalmology, Angamally, India
T P Ittyerah
Deptt. of Ophthalmology, Angamally, Kerala
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Ittyerah T P. Photocoreoplasty for updrawn pupil and S. T. Fernandez. Indian J Ophthalmol 1982;30:289-90
One of the late complications of cataract extraction is an updrawn pupil especially when there was vitreous disturbance during the procedure. When the patients vision does not improve due to ecentrically placed visual axis as a result of updrawn pupil the conventional treatment is surgical. With the introduction of Photocoagulation we can treat the updrawn pupil non-surgically by photocoagulating the iris. The mechanism is that the iris retracts on photocoagulation and the visual axis is brought towards the centre. The purpose of this communication is to share our experience in treating updrawn pupil following cataract extraction with Xenon Photocoagulation.
| MATERIALS and METHODS|| |
Five eyes were included in the study. The eyes were selected on the following basis :
1. They had updrawn pupil with the lower border well above the centre of the cornea.
2. They had fairly good vision during the immediate post operative period following cataract extraction.
3. The anterior chamber was not shallow especially at the central and below the central tone.
4. There was no thick after cataract visible at the pupillary area after application of Nydriatics. (In most cases Mydriatics will not work and only a small area at the upper part of the pupil will be visible.)
5. There was no associated glaucoma or active Iritis. Out of the five patients, 3 had intracapsular cataract extraction and one had extracapsular cataract extraction and in one case the method of extraction was not known.
Xenon Log-2 photocoagulator with attachments for Iris Photocoagulation was used for the procedure. The main attachment is a Convex Lens to focus the light over the iris. There is a special water bath to cool down the cornea during the procedure. The assistant holds the water bath and sees that it is always filled with saline during the procedure. It was done under retrobulbar anaesthesise with Xylocaine 2% Usually 20 to 30 applications are required to get the sufficient retraction of the iris. Diaphragm size was 6 and the time was one second in all the cases. In all the cases treatment was done only once. Usually one row of application was sufficient to retract the pupil sufficiently occasionally additional complete/incomplete second row of application was done. The patients were not hospitalised. They were given steroid and mydriatic drops and oxyphenbutazone 100 mg tablet for 10 days.
They were asked to continue steroids and mydriatics for one month and seen preferably every week to check for evidence of rise of tension and/or iritis.
Except for a mild post photocoagulation iritis there was no complications. The followup period varies from one year to six months.
| Discussion|| |
Xenon Photocoagulation of the iris is a useful method of treatment for aphakic decentred pupil. The procedure is simple and does not require hospitaliz_ltion. It is the ideal procedure in debilitated patients and patients reluctant tc undertake a second surgery. The reportec complications of iris photo coagulation are (a: Corneal Burn (Endothalial) (b) Cataract Formation (c) Pigment dispersal in the anterior chamber (d) Glaucoma (e) Iritis & (f) Iris haemorrhage. In this series no complication except for a mild iritis were encountered.
The complication of photocoagulation are trivial when compared to the serious complications that may be encountered following surgical correction of updrawn pupil. So I feel that Photocoreoplasty is the ideal treatment for updrawn pupil in selected cases, provided there is facility for photocoagulation. Our experience is limited to 5 eyes for a short period of follow up.
| Summary|| |
Iris Photo coagulation (Photo core oplasty) was tried in five eyes of aphakic updrawn pupil. In all the patients the vision remarkably improved and so far there was no serious complications during the follow-up period varying from 6 months to 1 year. In all the cases the treatment was done as an out patient procedure with Xenon Log-2 Photocoagulator with iris attachments.
[Table - 1]