Eyeworld

EW NEWS & OPINION 13 Regarding the patient's fixed and dilated pupil, there was discus- sion and consideration of various methods of iris repair. Dr. Hart prefers an iris cerclage for fixed di- lated pupils such as this one, while Dr. Beiko prefers interrupted 10-0 polypropylene sutures to reduce the pupil sequentially starting with two sutures 180 degrees apart. In this case, however, it oc- curred to me that despite the fixed mydriasis the iris did not appear at all atrophic at the slit lamp. Given that the patient's retina surgery was performed only 4 months previously I considered the possibility of dam- age to the efferent motor fibers to the iris from his PPV/endolaser. I've certainly seen many cases of damage to afferent fibers after similar surgery causing neurotrophic corneas that tend to slowly improve with time, and I wondered if this could be an iatrogenic Aide's type of pupil. If that were the case, the patient should respond to dilute pilocarpine with aggressive pupillary constric- tion due to denervation supersensi- tivity. Prior to planning his surgery I tested this hypothesis by placing one drop of 0.25% pilocarpine in his right eye. Note that even though this pa- tient's pupil did not respond at all to light he had an aggressive miotic re- sponse to the very dilute pilocarpine as one would see in an Aide's pupil due to post-synaptic denervation su- persensitivity. With this response it became clear to me that no surgery to the iris would be necessary. After the patient's secondary IOL surgery I treated him topically with 0.5% pilo drops BID for a few months, reduced to QD for another few months, and then ultimately discontinued about 6 months post-op as they were no longer required. No surgery to the iris was required in this case. "Great case … In this case a lit- tle pilo helped you clinch the diag- nosis. Do you routinely give patients a pilo trial when they come in for possible pupilloplasty?" Dr. Kim asked. The short answer to that ques- tion is that since this case came into my practice 2 years ago I do test pa- tients with pilocarpine if I think there is any possibility of efferent nerve damage contributing to the mydriatic picture—something to possibly consider the next time you see a patient in your practice with a pupil that appears fixed and dilated. EW Editors' note: Drs. Beiko, Hart, and Kim have no financial interests related to this article. Contact information Safran: safran12@comcast.net THE BEST OF BOTH WORLDS Only the GALILEI G2 merges the Placido and Dual Scheimpflug Technologies into a single measurement. The combined data provide highly accurate values for surgical evaluation and planning, leading to unrivalled clinical results Move to the next level of accuracy in Anterior Segment Tomography Call 1- 866-708-4490 or visit www.ziemergroup.com for further information about how GALILEI G2 can improve outcomes for your patients for surgical evaluation and planning, leading to unrivalled clinical results into a single measurement. The combined data provide highly accurate values Only the GALILEI G2 merges the Placido and Dual Scheimpflug T for surgical evaluation and planning, leading to unrivalled clinical results into a single measurement. The combined data provide highly accurate values Only the GALILEI G2 merges the Placido and Dual Scheimpflug T T THE BES for surgical evaluation and planning, leading to unrivalled clinical results into a single measurement. The combined data provide highly accurate values echnologies Only the GALILEI G2 merges the Placido and Dual Scheimpflug T H WORLDS T OF BO T Ridge Street, Alton, IL 62002, USA 1 32 Ziemer USA, Inc. about how GALILEI G2 can improve outcomes for your patients 866- - 1 Call Ridge Street, Alton, IL 62002, USA about how GALILEI G2 can improve outcomes for your patients .ziemergroup.com for further information 708-4490 or visit www 866- about how GALILEI G2 can improve outcomes for your patients .ziemergroup.com for further information December 2011

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