The Retrograde Iris Block - A Underdiagnosed Finding In Scleral Fixated Iols
Published 2023 - 41st Congress of the ESCRS
Reference: FP21.11 | Type: Free paper | DOI: 10.82333/z9he-kt71
Authors: Markus Schranz* 1 , Adrian Reumüller 2 , Victor Danzinger 2 , Marcus Lisy 2 , Daniel Schartmüller 2 , Christina Leydolt 2 , Claudette Abela-Formanek 2
1Ophthalmology and Optometry,Medical University of Vienna,Vienna,Austria;Ophthalmology and Optometry,Medical University of Vienna,Vienna,Austria, 2Ophthalmology and Optometry,Medical University of Vienna,Vienna,Austria
Purpose
To evaluate the frequencies of retrograde iris block in scleral fixated IOLs and to identify possible risk factors and treatment options
Setting
Department for Ophthalmology and Optometry, Medical University of Vienna, Austria
Retrospective study
Methods
We screened our records for patients who have undergone IOL implantation using the Carlevale, Yamane, Scharioth and 4 flanged IOL technique between January 2018 and February 2023.
Patients were only included if there was at least one sufficient post-operative anterior segment optical coherence tomography (AS-OCT) scan on the Casia 2 (Tomey, Japan) available.
AS-OCT scan was then evaluated first for IOL tilt and decentration using the 3D scan and then subsequently for anterior chamber angle (ACA) aqueous chamber depth (ACD), pupil diameter (PD) and iris-IOL distance (IOD) using the 0° axis 2D scan.
An iris IOL touch (IOD equals 0 or below 0) was considered as retrograde block (RB).
Results
112 patients met the inclusion criteria (48 females, 64 males), 42 patients were treated using the Carlevale, 32 the four flanged, 25 the Yamane & 13 the Scharioth technique, respectively. Mean age at surgery was 72±13years, pseudoexfoliation syndrome was found in 47eyes(42%).
RB was found in 38 patients (34%), if present mean ACA was 86°±16 compared to 55°±12 if not present.
We found a significant correlation between the presence of RB and PD(p<0.001) using logistic regression. In total 14 eyes with RB were treated using YAG-iridotomy, within 2 weeks the mean ACA decreased from 89° to 64°(p<0.001), mean ACD decreased from 4.5mm to 4.3mm(p=0.025), mean IOD increased from -0.03 to 0.37(p=0.001) and mean SPHE changed from -1.2 to -1.5(p=0.077).
Conclusions
Retrograde iris block is found in a third of eyes who have undergone scleral fixated IOL implantation without iridectomy. YAG iridotomy is a potent option to treat even long existing RBs, and subsequently reduce the risk of iris chaffing and secondary inflammation or glaucoma.