Basal iridectomy at 6 o'clock in the aphakic eye treated with silicone oil: prevention of keratopathy and secondary glaucoma.

Abstract

SUMMARYIn the aphakic eye, with intact iris diaphragm, silicone oil has frequently caused a pupillary block. In this situation aqueous humour accumulates behind the iris and forces silicone oil through the pupil into the anterior chamber. An iridectomy at the 6 o'clock position can effectively prevent this pupillary block. The iridectomy allows free passage of aqueous to the anterior chamber which remains free of silicone oil. No permanent contact with silicone oil and the cornea is established, and development of keratopathy is prevented. The effect of this iridectomy in 62 eyes with intact iris diaphragm in patients in Rotterdam (35 cases) and Nagoya (27 cases) is demonstrated. Only in 6*5% of the cases was silicone oil present in the anterior chamber at the end of the follow-up period of 7 months.

Management of Intraoperative and Postoperative Complications During Vitrectomy for Retinal Detachment

“…Anyway the development of keratopathies has been greatly reduced by the introduction of ando iridectomy [ 29 ], and this complication is now largely confi ned to eyes with severe trauma, hypotony, aniridia, or aphakia. Ando iridectomy consists of a 6 o'clock iridectomy preventing silicone oil from entering the anterior chamber.…”

Postoperative Komplikationen nach Silikonölinstillation

“…Silikonol-Endothelkontakt fiihrt zu Endothelzellverlust and Bildung einer retrokornealen Membran [10,17]. Ublicherweise tritt die Keratopathie als bandformige Keratopathie oder seltener als diffuses bulloses Hornhautodem in Erscheinung [6,20] [39].…”

“…Eine der bedeutendsten Schritte zur Reduktion dieser Komplikationen nach Silikonolinstillation war die Einfiihrung der basalen Iridektomie bei 6 Uhr durch Ando [2,3]. Sie reduzierte die Inzidenz des postoperativen Pupillarblockglaukoms, Silikonolprolapses in die Vorderkammer and der postoperativen Keratopathie erheblich [6], ohne jedoch das Problem vollstandig zu losen. In vielen Fallen funktioniert die inferiore Iridektomie in der postoperativen Phase nicht.…”

The Use of Polymers in the Treatment of Retinal Detachment: Current Trends and Future Perspectives

“…Other problems such as angle-closure or pupillary-block glaucoma, inflammation and keratopathy may also be associated with SiOs [121,123]. In order to reduce the risk of pupillary-block glaucoma and to keep the anterior chamber free of silicone in aphakic eye, it is necessary to avoid overfilling and, in addition, inferior peripheral iridectomy can be helpful to allow the silicone globules to return to the vitreous cavity when the patient is in the prone position [125]. Cataract may eventually develop in phakic eyes because of blocked nutrient diffusion across the posterior lens capsule (incidence usually within 6-18 months after surgery) [126,127].…”