eMedicine Specialties > Ophthalmology > Pupil

Pupillary Block, Aphakic: Follow-up

Author: Deborah R Eezzuduemhoi, MD, Assistant Professor, Department of Ophthalmology and Visual Sciences, Texas Tech University, Health Sciences Center School of Medicine
Coauthor(s): Deborah Wilson, MD, Director of Glaucoma Service, Assistant Professor, Department of Ophthalmology, Georgetown University Medical Center
Contributor Information and Disclosures

Updated: Jul 23, 2008

Follow-up

Further Inpatient Care

  • It is necessary to check the IOP 1 hour after the operation.
  • The patient usually is discharged home after iridotomy or iridectomy with instruction to return to the eye clinic within 24 hours.

Inpatient & Outpatient Medications

  • The patient is instructed to use the prescribed medications (see Medication).

Complications

  • Iridectomy
    • Hyphema
    • Corneoscleral wound infection
  • Laser iridotomy - Hyphema

Prognosis

  • If the pupillary block is treated promptly, IOP will return to the reference range, ocular symptoms will be ameliorated, and the visual acuity will improve.

Patient Education

  • Teach patients to recognize the symptoms and to seek eye care promptly.

Miscellaneous

Medicolegal Pitfalls

  • Early detection and treatment helps to reduce permanent visual loss.

Special Concerns

  • The most important point regarding pupillary block in aphakia is prevention.
    • Primary surgical iridectomy is recommended following cataract extraction in eyes with intact posterior capsule without intraocular lens placement. If surgical iridectomy is not performed because of small incision surgery, subsequent laser iridotomy is recommended.
    • An iridectomy at the 6-o'clock position, performed primarily as a routine addition to silicone oil surgery or as a secondary intervention, has been shown to prevent pupillary block. The inferior location of the iridectomy allows the free passage of the aqueous anteriorly, while the lighter oil floats posteriorly and on the top.
    • For aphakic eyes undergoing intravitreal gas injection, a large inferior iridotomy in the 6-o'clock position is recommended at the time of the primary procedure, especially in patients who are likely to have poor compliance with appropriate postoperative positioning.
    • The management of chronic secondary glaucoma following congenital cataract surgery is challenging. Young age, subconjunctival scarring, aphakia, and prior surgery are significant risk factors. Peripheral iridectomy should be considered and performed not only in complicated pediatric cataract extraction cases but also in routine pediatric cataract extraction cases, because vitreous remnants are commonly seen postoperatively in the anterior chamber despite an anterior vitrectomy.
    • Multiple sphincterectomies are recommended.
 


More on Pupillary Block, Aphakic

Overview: Pupillary Block, Aphakic
Differential Diagnoses & Workup: Pupillary Block, Aphakic
Treatment & Medication: Pupillary Block, Aphakic
Follow-up: Pupillary Block, Aphakic
References
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References

  1. Kumar A, Kedar S, Garodia VK. Angle closure glaucoma following pupillary block in an aphakic perfluoropropane gas-filled eye. Indian J Ophthalmol. Sep 2002;50(3):220-1. [Medline].

  2. Shaffer RN. The role of vitreous detachment in aphakic and malignant glaucoma. Trans Am Acad Ophthalmol Otolaryngol. 1954;58:217-231.

  3. Posner A. Postcataract glaucoma associated with shallow anterior chamber. Int Ophthalmol Clin. 1964;4:1029-1043.

  4. Beekhuis WH, Ando F, Zivojnovic R, et al. Basal iridectomy at 6 o'clock in the aphakic eye treated with silicone oil: prevention of keratopathy and secondary glaucoma. Br J Ophthalmol. Mar 1987;71(3):197-200. [Medline].

  5. Chandler PA. Glaucoma from pupillary block in aphakia. Arch Ophthalmol. 1962;7:44-47.

  6. Chandler PA, Simmons RJ. Gonioscopy during surgery for aphakic eyes with pupillary block. Am J Ophthalmol. Oct 1972;74(4):571-80. [Medline].

  7. Cotlier E. Aphakic flat anterior chamber. IV. Treatment of pupillary block by iridectomy. Arch Ophthalmol. Jul 1972;88(1):22-6. [Medline].

  8. Jaffe NS, Light DS. The danger of air pupillary block glaucoma in cataract surgery with osmotic hypotonia. Arch Ophthalmol. Nov 1966;76(5):633-4. [Medline].

  9. Koc F, Kargi S, Biglan AW, et al. The aetiology in paediatric aphakic glaucoma. Eye. Dec 2006;20(12):1360-5. [Medline].

  10. Mandal AK, Bagga H, Nutheti R. Trabeculectomy with or without mitomycin-C for paediatric glaucoma in aphakia and pseudophakia following congenital cataract surgery. Eye. Jan 2003;17(1):53-62. [Medline].

  11. Tomey KF, Traverso CE. Neodymium-YAG laser posterior capsulotomy for the treatment of aphakic and pseudophakic pupillary block. Am J Ophthalmol. Nov 15 1987;104(5):502-7. [Medline].

  12. Tomey KF, Traverso CE. The glaucomas in aphakia and pseudophakia. Surv Ophthalmol. Sep-Oct 1991;36(2):79-112. [Medline].

  13. Zborowski-Gutman L, Treister G, Naveh N, et al. Acute glaucoma following vitrectomy and silicone oil injection. Br J Ophthalmol. Dec 1987;71(12):903-6. [Medline].

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Further Reading

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Keywords

pupillary block, aphakic pupillary block, aphakia, pupillary block glaucoma, angle closure, cataract surgery, cataracts, cataract extraction, crystalline lens, lens implantation, lens subluxation, anterior pupillary block, posterior pupillary block, intraocular trauma

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Contributor Information and Disclosures

Author

Deborah R Eezzuduemhoi, MD, Assistant Professor, Department of Ophthalmology and Visual Sciences, Texas Tech University, Health Sciences Center School of Medicine
Deborah R Eezzuduemhoi, MD is a member of the following medical societies: American Academy of Ophthalmology, American Academy of Pediatrics, and Women in Ophthalmology, Inc
Disclosure: Nothing to disclose.

Coauthor(s)

Deborah Wilson, MD, Director of Glaucoma Service, Assistant Professor, Department of Ophthalmology, Georgetown University Medical Center
Deborah Wilson, MD is a member of the following medical societies: American Academy of Ophthalmology and American College of Physicians
Disclosure: Nothing to disclose.

Medical Editor

Neil T Choplin, MD, Adjunct Clinical Professor, Department of Surgery, Section of Ophthalmology, Uniformed Services University of Health Sciences
Neil T Choplin, MD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, Association for Research in Vision and Ophthalmology, and California Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

J James Rowsey, MD, Former Director of Corneal Services, St Luke's Cataract and Laser Institute, Florida
J James Rowsey, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for the Advancement of Science, American Medical Association, Association for Research in Vision and Ophthalmology, Florida Medical Association, Pan-American Association of Ophthalmology, Sigma Xi, and Southern Medical Association
Disclosure: Nothing to disclose.

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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