EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/176967
16 EW NEWS & OPINION September 2013 Where's continued from page 15 good mentation and otherwise is active and mobile, I do think consideration for surgery can be given. If I could convince myself that there is better than light perception vision, then opening the pupil can be considered. A simple, less invasive option would be using the YAG laser for a membrane lysis with the goal of making a very small opening in the membrane to see if any improve- ment in vision is noted and possibly to get a view to the posterior pole. If by chance it does, the opening could be completed with the YAG laser; if not, then an intraocular approach to pupillary membrane removal could be done with viscodissection, endgripping forceps with peeling of the membrane +/– scissors or blunt dissection if need be. Figure 5: Left eye of a 62-year-old woman with history of trauma as a 4-year-old leading to cornea scar, with iris adherent to cornea and membrane preventing view of the retina Figure 6: Patient's eye after penetrating keratoplasty, iris reconstruction, removal of fibrotic scar tissue, vitrectomy and scleral-sutured posterior chamber IOL. Although vision was limited by amblyopia, she did get some useful vision out of this eye. Source (all): Steven G. Safran, MD What was done I/A HANDPIECE Excellent for Use in ALL Phases of I/A Flexible Tip Smooth Irrigation and Aspiration Ports www.StorzEye.com/CapsuleGuard MICS 1.8mm Incision Enhanced Visualization from Semi-transparent Silicone 2.2mm - 2.8mm Incision Flexible Sleeve Design Conforms to Wound to Seal Incision Designed with No Sharp Edges to Reduce Risk of Capsule Rupture Straight Curved 45° Available in Tip Styles and Incision Sizes Available in 3 Tip Styles and 2 Incision Sizes CALLYOUR INSTRUMENT SPECIALIST CALLYOUR INSTRUMENT SPECIALIST AT 1-800-338-2020 TO ORDER AT 1-800-338-2020 TO ORDER OR TO REQUEST TRIAL OR TO REQUEST A TRIAL ®/™ are trademarks of Bausch Lomb Incorporated or its afliates. Bausch Lomb Incorporated. ®/™ are trademarks of Bausch & Lomb Incorporated or its afliates. © Bausch & Lomb Incorporated. This patient was wheelchair bound and very tired and exasperated with waiting and being moved around in my office. I don't have a B-scan in my office but rather refer those to the retina practice down the block who will do the B-scan and send the patient right back to me. I suggested to the patient and her family that I wanted to send her over for a Bscan, and the patient was extremely upset. I decided to forgo the B-scan and examined her with transillumination and did not see any evidence of a mass. She had good light projection as well so I decided to simply go ahead and attempt the YAG laser. This was done immediately and, to my surprise, the membrane completely resolved and she had 20/20 vision a few minutes after the laser treatment. Figures 3 and 4 are the images immediately after treatment. After this treatment I was able to easily view the retina and see that there was no posterior segment pathology. The patient did extremely well after that with no recurrence of the membrane, and needless to say she and her family were thrilled. I'm not sure why this patient developed a fibrotic oblation of the pupil after years of being stable, but fortunately the problem resolved without sequelae. This case reminds me of a somewhat similar situation I had encountered previously where a 62-year-old nurse presented for consideration of repair of her right eye, which suffered trauma as a 4-year-old. She had no pupil at all nor was there a view of the retina. She also had a cornea scar (Figure 5). In order to determine what was going on in back of the eye here I created a small opening with a YAG laser in the membrane. Although the opening was difficult to see through, I was able to get excellent OCT images of her optic nerve and retina in this eye, which were essentially normal. A decision was made, based on the above information, to go ahead with a cornea transplant, sutured PCIOL and attempt at a pupil reconstruction, which was done successfully (Figure 6). The patient did recover some useful vision in this eye, which was fortunate because two weeks after this surgery was performed, she presented with an unrelated central retina vein occlusion in her other "good" eye. EW Editors' note: The physicians have no financial interests related to this article. Contact information Doane: jdoane@discovervision.com Fisher: JMFeyeMD@comcast.net Hart: j.c.hartjr@sbcglobal.net Safran: safran12@comcast.net Sulewski: Michael.Sulewski@uphs.upenn.edu