Repair of angle recession prevents pupillary capture of intrasclerally fixed intraocular lenses.

PURPOSE: We evaluated a new concept for treating pupillary capture of the intraocular lens (IOL) following intrascleral fixation of the IOL. Pupillary capture of the IOL is a common postoperative complication that occurs after suturing and intrascleral fixation of the IOL. In such cases, blunt trauma is often related to zonular dialysis, iris retraction, iridodonesis, and angle recession. Several methods such as barricading by suturing, pupilloplasty, and pars plana fixation are reported to prevent pupillary capture. Although effective, none of these techniques fix iris-malposition and angle recession. We considered that repairing angle recession could correct the iris position and prevent pupillary capture recurrence. METHODS: We repaired angle recession in four cases and have followed up. RESULTS: Pupillary capture was not observed in all three cases of larger IOLs for more than 9 months, but observed after 1 month in an IOL with normal 6 mm diameter, in which the angle was not properly lifted. CONCLUSION: In select cases, repairing angle recession may be useful for preventing pupillary capture after IOL suturing and intrascleral fixation.

Baerveldt tube shunt implantation through a long scleral tunnel.

PURPOSE: To develop a new technique for the placement of a Baerveldt glaucoma implant tube through a long scleral tunnel. MATERIALS AND METHODS: Patients with refractory glaucoma undergoing the maximum tolerated medical therapy were recruited. We created a scleral tunnel with a 24-gauge catheter needle and used the external tube for guidance when introducing a Baerveldt glaucoma implant tube. Main outcome measures included intraocular pressure, supplemental medical therapy score, intraoperative complications, and postoperative complications. RESULTS: Nine eyes of six patients were included in the study. The mean preoperative intraocular pressure (score) was 41.0 mmHg (4.78). Mean postoperative intraocular pressures were 18.3 mmHg (0.22), 18.8 mmHg (0.13), and 16.9 mmHg (0.50) at postoperative 1, 3, and 6 months, respectively. Minor vitreous hemorrhages were observed in three cases. Postoperative hypotony (<5 mmHg) was observed only in the first case at postoperative day 3. In one case, a stent suture could not be placed because the patient was restive intraoperatively, which resulted in an expulsive hemorrhage at 3 months postoperatively. The tube could have penetrated into the anterior chamber in another case. Tube exposure and corneal erosions were not observed in all cases. CONCLUSION: We developed a new technique to place a Baerveldt glaucoma implant tube through a long scleral tunnel. The outcomes were comparable to other reports of Baerveldt glaucoma implant surgery, although the number of cases was limited in this study. A long scleral tunnel can substitute for a preserved scleral patch and self-scleral flap to avoid tube-related complications.