Pinhole pupilloplasty can correct astigmatism after manual small-incision cataract surgery
Click Here to Manage Email Alerts
Manual small-incision cataract surgery is an established method to perform cataract removal and is often considered as an alternative and a standby procedure to phacoemulsification in selected cases with associated ocular comorbidity.
An inadvertent complication during a phacoemulsification procedure often requires conversion to manual small-incision cataract surgery (MSICS). Despite comprehensive preoperative assessment, surgically induced astigmatism (SIA) can occur postoperatively in MSICS. The impact of residual astigmatism on visual acuity is immense and leads to patient dissatisfaction. All variations of MSICS techniques entail shaping of a self-sealing sclerocorneal tunnel that can directly influence SIA depending on its length, shape, regularity, distance from the limbus and extent into the clear cornea. The surgical procedure of pinhole pupilloplasty (PPP) has been described for correction of higher-order aberrations arising from the corneal surface. We hereby report the application of performing PPP to curtail the effect of high postoperative astigmatism following MSICS.
The method of performing PPP has been described previously. In brief, single-pass four-throw pupilloplasty is performed to achieve a pinhole pupil of approximately 1.5 mm to 2 mm in diameter that is centered on the Purkinje 1 reflex emanating from the coaxial light of the surgical microscope.
Two cases presented after MSICS with a similar history of decrease in vision following an uncomplicated cataract surgery. Spectacle correction provided no relief as case 1 had residual refractive error of –5 D cylinder at 85° and case 2 had –4.5 D cylinder at 25°. Both cases underwent PPP, and there was a significant improvement in the preoperative and postoperative period for uncorrected and best corrected visual acuity for all viewing distances (distance, intermediate and near) under photopic and mesopic light conditions (Table 1). Clinical Trial Suite (M&S Technologies) was used to record data as it allows the luminance levels to be controlled and contrast levels to be adjusted as specified in the ANSI, ISO and consensus statement of the accommodative intraocular lens task force.
Previous analysis following PPP revealed that patients demonstrate a defocus curve that ranges from +1.5 D to –2.5 D. As we had only two cases, defocus curve was not calculated, although similar results are expected for these cases as the patients were comfortable for all viewing distances. The pinhole effect provides a wide range of accommodation that facilitates better tolerance to residual refractive errors.
Source: Priya Narang, MS, and Amar Agarwal, MS, FRCS, FRCOphth
To summarize, satisfactory outcomes are reported after performing PPP in post-MSICS to tackle high astigmatism. Although there are multiple methods to correct astigmatism in post-cataract patients, PPP can be considered as a viable option.
- References:
- MacRae S, et al. Ophthalmology. 2017;doi:10.1016/j.ophtha.2016.09.039.
- Narang P, et al. Eur J Ophthalmol. 2017;doi:10.5301/ejo.5000922.
- Narang P, et al. J Cataract Refract Surg. 2019;doi:10.1016/j.jcrs.2018.12.007.
- Narang P, et al. J Cataract Refract Surg. 2019;doi:10.1016/j.jcrs.2019.02.037.
- Narang P, et al. J Cataract Refract Surg. 2020;doi:10.1097/j.jcrs.0000000000000421.
- Narang P, et al. J Refract Surg. 2020;doi:10.3928/1081597X-20201008-01.
- Ruit S, et al. Curr Opin Ophthalmol. 2018;doi:10.1097/ICU.0000000000000442.
- For more information:
- Amar Agarwal, MS, FRCS, FRCOphth, is director of Dr. Agarwal’s Eye Hospital and Eye Research Centre. Agarwal is the author of several books published by SLACK Incorporated, publisher of Ocular Surgery News, including Phaco Nightmares: Conquering Cataract Catastrophes, Bimanual Phaco: Mastering the Phakonit/MICS Technique, Dry Eye: A Practical Guide to Ocular Surface Disorders and Stem Cell Surgery and Presbyopia: A Surgical Textbook. He can be reached at 19 Cathedral Road, Chennai 600 086, India; email: aehl19c@gmail.com; website: www.dragarwal.com.
- Priya Narang, MS, can be reached at Narang Eye Care & Laser Centre, Ahmedabad, India; email: narangpriya19@gmail.com.
Collapse
Read more about
Click Here to Manage Email Alerts