Eyeworld

19 EW NEWS & OPINION February 2019 keratoconus. "In all such cases, you can do a pinhole pupilloplasty," Dr. Agarwal said. The results with the technique have gone beyond Dr. Agarwal's expectations. He recalled one of his patients who received a corne- al patch graft resulting in 20 D of astigmatism. Instead of doing a com- plex keratoplasty on the patient, Dr. Agarwal decided to perform pinhole pupilloplasty. "I said, 'Let me make this pupil small and see what hap- pens,' and after that, the man was reading five lines on the board," he said. "With 20 D of astigmatism, I was in total shock." What's more, he has found that the pinhole could give patients an extended depth of focus, enabling them to see well simultaneously at distance and near. For example, Dr. Agarwal had a patient with a corneal injury because of a glass foreign body, which left him with high astigmatism. "When I did a pinhole pupilloplasty for him, he was so happy because he could see both distance and near," Dr. Agarwal said. With the four-throw procedure, it is also still possible to get some limited dilation, he noted. "So fundus examination is possible," Dr. Agarwal said, adding that if some- thing more extensive is needed, such as for a case of retinal detachment, it is possible to YAG the iris and undo the procedure. One caveat with the pupilloplas- ty is that if a patient has a normal crystalline lens, he or she needs to be made pseudophakic before per- forming the procedure, Dr. Agarwal cautioned. "When you do a pupil- loplasty, it may touch the crystalline lens and create a cataract," he said. It's also not possible to do the procedure if the patient doesn't have any iris present. "But these are very small disadvantages from what I'm seeing because the advantages are huge," he said. Determining if someone may be a good candidate for the proce- dure can be as simple as holding a pinhole in front of their eye. "If the patient improves with a pinhole, they will improve with a pinhole pupilloplasty," Dr. Agarwal said. "You can tell the patient, 'You are improving with the pinhole. I will make your pupil smaller to about 1.5 mm and your astigmatism will be neutralized.'" The result will be a Contact information Agarwal: aehl19c@gmail.com patient who only needs to undergo a quick procedure and who will likely be extremely happy, he said. EW Editors' note: Dr. Agarwal has no financial interests related to his comments. XEN ® is a registered trademark of Allergan KI-Adv-080618-Rev 0 ® K5-7500 Grasping Forceps smooth, non-irrigating, black handle 08-04418 Vera Hook K30-1015 Single Mirror Lens sterile, disposable, 10/box 08-08105T-001 Kratz/Barraquer Speculum heavy wire K5-5058 Buratto Forceps disc-shaped tips, serrated jaws K5-5000 McPherson Tying Forceps straight, 5mm platform K3-9000 Castroviejo Caliper straight A new procedure requires different tools ® (800) 225-1195 info@katena.com www.katena.com Instruments for the XEN Gel Stent Contact us today

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