Indian Journal of Ophthalmology

ARTICLES
Year
: 1982  |  Volume : 30  |  Issue : 4  |  Page : 289--290

Photocoreoplasty for updrawn pupil and S. T. Fernandez


TP Ittyerah 
 Deptt. of Ophthalmology, Angamally, India

Correspondence Address:
T P Ittyerah
Deptt. of Ophthalmology, Angamally, Kerala
India




How to cite this article:
Ittyerah T P. Photocoreoplasty for updrawn pupil and S. T. Fernandez.Indian J Ophthalmol 1982;30:289-290


How to cite this URL:
Ittyerah T P. Photocoreoplasty for updrawn pupil and S. T. Fernandez. Indian J Ophthalmol [serial online] 1982 [cited 2020 Sep 22 ];30:289-290
Available from: http://www.ijo.in/text.asp?1982/30/4/289/29452


Full Text

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.