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Pseudophakic Reverse Pupillary Block Following Sutureless Scleral Fixation of Intraocular Lens: Diagnostics and Treatment

Karolina Krix-Jachym, Natalia Blagun, Kinga Naszkiewicz-Blachnio, Marek Rekas

Background: The aim of the study was to present clinical symptoms and provide results of optical coherence tomography examination of the anterior segment in patients who underwent iridotomy for the treatment of pseudophakic reverse pupillary block.

Case presentation: The analysis focused on two patients who, during postoperative follow-up after previously performed sutureless scleral fixation of a foldable three-piece intraocular lens, were found to have a very deep anterior chamber, a concave iris configuration and contact between the Intraocular Lens (IOL) optics and the iris. Based on clinical imaging and optical coherence tomography examination, pseudophakic reverse pupillary block was diagnosed. In both cases, laser iridotomy was performed.

Results: Improved anatomical relationships and resolution of symptoms associated with reverse pseudophakic pupillary block were confirmed in clinical and optical coherence tomography examinations.

Conclusion: Laser iridotomy in cases of pseudophakic reverse pupillary block allows restoration of normal anatomical relationships, reduces lens-iris contact, regulates intraocular pressure and avoids unnecessary surgical interventions. Optical coherence tomography technology enhances clinical imaging quality and facilitate managing this complication.