Pseudophakic Pupillary Block Follow-up

Updated: May 02, 2018
  • Author: Mitchell V Gossman, MD; Chief Editor: Douglas R Lazzaro, MD, FAAO, FACS  more...
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Follow-up

Further Outpatient Care

Regular, prolonged follow-up care is needed to observe and preserve the normal anatomy of the anterior segment, the clarity of the refractive media, and the maintenance of normal IOP. Monitoring of visual fields and visual acuity also is important.

Pediatric patients need special care during the postoperative period. They may need sedation or even general anesthesia for a proper and thorough examination.

Examine for uveitis by performing a careful slit lamp examination at every visit. In particular, examine for the presence of aqueous flare and cells and deposits on both the corneal endothelium and the optics of the IOL. The position of the IOL is monitored for centration of the optic, deposition of pigment or foreign body giant cells, and any adhesions that may be developing with the iris. Lifelong, regular follow-up care is important. Explain at every visit the current status of the eye. Strongly advise the patient to come for regular check-ups after 1, 2, or 3 months or longer (as the situation demands).

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Inpatient & Outpatient Medications

Local and systemic medication depends on both the condition and the needs of a particular patient.

Most of the operated cases generally need mydriatics, anti-inflammatory medications (steroidal and nonsteroidal), and antiglaucoma medicines.

The frequency of local instillation, the dose of oral medication, and the length of medication are determined by the needs of the individual patient.

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Transfer

An experienced surgeon and adequate facilities must be available to manage these patients. If not available, transfer of the patient is warranted.

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Complications

Patients with glaucoma who are untreated or poorly treated experience loss of visual acuity and visual fields, which may result in total visual loss.

Corneal decompensation may result from endothelial damage caused by the sudden rise in IOP or prolonged uncontrolled IOP. It also may result from contact with an anteriorly displaced IOL.

Uveitis may result from iris and/or ciliary irritation from the IOL or vitreous, as well as breakdown of the blood-aqueous barrier due to acute glaucoma. Surgery may lead to prolonged inflammation.

Chronic inflammation and/or vitreous in contact with the iris may lead to the development of cystoid macular edema with reduced visual acuity, even after the IOP problem has been corrected.

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Prognosis

The earlier the condition is detected and adequately treated, the greater the chance of a full recovery. Once it is found that the pupillary block is not amenable to conservative treatment and an early surgical correction is instituted, the chances of recovery are excellent.

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Patient Education

All patients undergoing intraocular surgery should be advised to contact the surgeon immediately if they experience pain or sudden decreases in vision in the postoperative period. These signs could indicate the development of pupillary block and acute glaucoma.

Patients should be aware of the need for regular follow-up visits to detect such problems before they result in serious vision-threatening conditions.

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