Iris Cerclage To Treat Persistent Mydriasis Following Acute Angle Closure Glaucoma Improves Visual Quality.

PRCIS: We developed a modified iris cerclage technique that improves best corrected visual acuity, pupillary parameters, self-assessed photophobia, and visual function index-14 questionnaire scores in patients with acute primary angle closure and permanent mydriasis after cataract surgery. PURPOSE: To evaluate the efficacy of a modified iris cerclage technique in patients with acute primary angle closure (PAC) and permanent mydriasis after cataract surgery. PATIENTS AND METHODS: 12 eyes of 12 patients with acute PAC and permanent mydriasis at more than 3 months after phacoemulsification combined with intraocular lens (IOL) implantation underwent modified iris cerclage. Best corrected visual acuity (BCVA), intraocular pressure (IOP), pupil diameter, and visual function index-14 (VF-14) questionnaire and self-assessed photophobia scores before surgery and at 1 week, 1 month, and 3 months postoperatively were compared. Further, the postoperative pupil position and morphology and complications were evaluated. RESULTS: BCVA improved from 0.48±0.23 preoperatively to 0.28±0.15, 0.27±0.15, and 0.26±0.14 at 1 week, 1 month, and 3 months postoperatively, respectively (P=0.008). No significant difference was observed between the preoperative and postoperative IOP (P=0.974). Pupil diameter improved from 6.34±0.51 mm preoperatively to 3.59±0.33, 3.59±0.34, and 3.58±0.32 mm at 1 week, 1 month, and 3 months postoperatively, respectively (P<0.001). Self-assessed photophobia scores improved from 3.33±0.78 preoperatively to 0.83±0.72, 0.51±0.15, and 0.45±0.14 at 1 week, 1 month, and 3 months postoperatively, respectively (P<0.001). VF-14 scores improved from 47.6±6.1 points preoperatively to 67.9±6.2, 72.1±6.1, and 73.5±6.0 points at 1 week, 1 month, and 3 months postoperatively, respectively (P<0.001). Postoperatively, all pupils were centered and round. No postoperative complications, such as iris-suture slippage, iridodialysis, or exposure of the IOL's optical zone edge, were observed. CONCLUSION: Modified iris cerclage creates a centered, precisely sized, round pupil. It improves visual quality in patients with acute PAC and permanent mydriasis after cataract surgery.

Sutureless intrascleral intraocular lens fixation and modified iris cerclage pupilloplasty for aphakia and traumatic mydriasis.

PURPOSE: To evaluate the safety and efficacy of sutureless intrascleral intraocular lens (IOL) fixation combined with modified iris cerclage pupilloplasty for treating aphakia and traumatic mydriasis. METHODS: Five patients with aphakia and traumatic mydriasis were operated on by the same surgeon. All patients underwent sutureless intrascleral IOL fixation combined with modified iris cerclage pupilloplasty and were followed up for ≥6 months. Best-corrected visual acuity (BCVA) was measured using the logarithm of the minimum angle of resolution (logMAR). BCVA, intraocular pressure (IOP), pupil diameter, and corneal endothelial cell count (CECC) preoperatively and postoperatively were statistically analyzed. The pupil shape, photophobia, IOL position, and surgical complications were evaluated. RESULTS: The mean BCVA was significantly improved 6 months postoperatively (0.26 ± 0.17 logMAR, P = 0.042) than preoperatively (0.50 ± 0.30 logMAR). No significant difference was observed between the preoperative and postoperative IOP (P = 0.138). The mean pupil diameter significantly reduced postoperatively than preoperatively (3.44 ± 0.35 mm vs. 7.28 ± 0.35 mm, P = 0.043). There was no significant decrease in CECC postoperatively (P = 0.225). The pupil shape was round-like, and photophobia disappeared in all patients. No intraoperative or postoperative complications occurred. CONCLUSION: Sutureless intrascleral IOL fixation combined with modified iris cerclage pupilloplasty is a safe and efficient procedure for treating aphakia traumatic mydriasis patients without sufficient capsular support.

Combined Use of Anti-VEGF Drugs Before and During Pars Plana Vitrectomy for Severe Proliferative Diabetic Retinopathy.

INTRODUCTION: This study aimed to evaluate the combined administration of anti-vascular endothelial growth factor (anti-VEGF) drugs before and during pars plana vitrectomy (PPV) and to explore its efficacy and safety in the treatment of patients with severe proliferative diabetic retinopathy (PDR). METHODS: This retrospective case series included consecutive patients who underwent PPV. Patients were categorized into two groups: the preoperative group was injected with anti-VEGF drugs before PPV, and the combination group was injected with anti-VEGF drugs before and during PPV. Preoperative, intraoperative, and postoperative clinical data were collected for analysis. The main outcome measures were changes in best-corrected visual acuity (BCVA) and central retinal thickness (CRT) and occurrence of postoperative vitreous cavity haemorrhage (POVCH). RESULTS: In total, 63 eyes of 60 patients with severe PDR were analysed. The operative duration and occurrence of intraoperative haemorrhage, iatrogenic retinal breaks, and silicone oil tamponade were similar between the two groups. The benefits on BCVA, and CRT after 1 week postoperatively, were more obvious in the combination group (P < 0.01). Combination therapy had the potential to reduce the incidence of POVCH. No ocular or systemic adverse events occurred in either group. CONCLUSIONS: The combined use of anti-VEGF drugs before and during PPV in patients with severe PDR not only includes the advantages of preoperative injection, but also has more significant prognostic benefits and favourable safety profiles.