Microperipheral Iridectomy for Troublesome Posterior Synechiolysis in Secondary Intraocular Lens Implantation

Abstract

Purpose: To introduce an effective method for separating extensive posterior synechiae and those located under or adjacent to surgical incisions.

Methods: Pediatric patients who had been subjected to cataract surgery and developed troublesome posterior synechiae requiring secondary intraocular lens (IOL) implantation were recruited. All patients underwent microperipheral iridectomy at the 12 o'clock position. Then, an ophthalmic viscosurgical device was injected into the posterior chamber through the iris fistula to mechanically separate the posterior synechiae, using scissors to cut robust posterior synechiae if necessary. The results of posterior synechiolysis and the position of the implanted IOL were analyzed.

Results: Sixteen patients (median age, 51.56 months; range, 28-80 months) were included. The scope of posterior synechia in clock was 4.42 (range, 1-10). All troublesome posterior synechiae were successfully separated using the microperipheral iridectomy method, and all patients underwent IOL implantation in the ciliary sulcus. There was one case of peripheral iridectomy-related early intraoperative bleeding; no bleeding was observed at the end of surgery.

Conclusions: Microperipheral iridectomy is a useful method for the management of troublesome posterior synechiae during secondary IOL implantation in pediatric patients, which makes secondary IOL implantation an easier and safer method in some challenging cases.

Figure 1

Representative anterior segment images before and after posterior synechiolysis. (a) Preoperative image of extensive and superior posterior synechia. Position, 6–3 o'clock. (b) Postoperative condition of (a), showing a round pupil, a centrally placed IOL, and a barely noticeable peripheral iridectomy.

Figure 2

The anterior segment of the patient who exhibited intraoperative bleeding. This case presented with superior corneal leukoma (red arrows), superior posterior synechiae with fibrous membrane (yellow arrow), and peripheral anterior synechiae.