Pupillary Abnormalities in Descemet Membrane Endothelial Keratoplasty After Nearly Full Tamponade



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Arnalich Montiel, Francisco and Pérez Sarriegui, Ane and Lauzirika, Gorka and Porrua, Laura and Hernández Verdejo, José Luis (2017) Pupillary Abnormalities in Descemet Membrane Endothelial Keratoplasty After Nearly Full Tamponade. Cornea, 36 (3). pp. 290-294. ISSN 0277-3740

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Official URL: https://doi.org/10.1097/ICO.0000000000001141


Purpose: To describe the incidence, risk factors, and management of pupillary abnormalities after anterior chamber (AC) full air or gas tamponade in Descemet membrane endothelial keratoplasty (DMEK) without pupillary block.
Methods: In this retrospective case series, clinical records of 25 patients (32 eyes) who underwent DMEK were reviewed for pupillary abnormalities and iris morphology. All patients had nearly full intracameral tamponade with air or 20% SF6 at the end of surgery without default air release postoperatively.
Results: Pupillary abnormalities ranging from mild ovalization to mid-mydriasis were seen in 56% of the cases. These abnormalities were not related to morphometric changes in the iris volume, or in the iris dilator or iris sphincter muscle, but were probably due to posterior synechiae. Combining DMEK and cataract surgery increases by 5-fold the odds of developing this complication. Surgical revision of the posterior surface of the iris and synechiolysis reversed these pupillary abnormalities.
Conclusions: Nonischemic pupillary abnormalities can be seen in patients with DMEK using a nearly full air/gas tamponade in the AC after surgery despite patent iridectomy especially when combined with cataract surgery. Ensuring complete mydriasis in the immediate postoperative period and a free-floating bubble in the AC above the inferior pupillary margin may reduce its incidence.

Item Type:Article
Additional Information:

Received for publication October 15, 2016; revision received November 27, 2016; accepted November 29, 2016. Published online ahead of print January 2017

Uncontrolled Keywords:DMEK, pupil, SF6, gas, tamponade, synechiae, iris
Subjects:Medical sciences > Medicine > Surgery
Medical sciences > Medicine > Ophtalmology
Medical sciences > Optics > Eyes anatomy
ID Code:44550
Deposited On:11 Sep 2017 12:57
Last Modified:12 Sep 2017 11:39

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