Anterior segment optical coherence tomography findings of reverse pupillary block after scleral-fixated sutured posterior chamber intraocular lens implantation

Purpose To evaluate findings of reverse pupillary block after scleral-fixated sutured posterior chamber intraocular lens (PC IOL) implantation using anterior segment optical coherence tomography (AS-OCT) and report a possible association with postoperative complications. Setting Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan. Methods Anterior segment OCT was used to evaluate eyes with reverse pupillary block (ie, deep anterior chamber, concave iris configuration, contact between pupil and IOL) after IOL explantation or cataract extraction combined with vitrectomy and scleral-fixated sutured PC IOL implantation. The PC IOL was implanted using an ab externo method in all cases. After 2 scleral flaps were created 180 degrees apart, a straight needle attached to a 10-0 polypropylene suture for IOL fixation was passed through the bed of half-thickness scleral flaps 2.0 mm posterior to the limbus in a direction parallel to the iris. Results Four eyes (3 patients) were evaluated. Anterior segment OCT showed a concave iris configuration with an increase in anterior chamber depth and anterior chamber angle in all cases. Two eyes had intermittent pupil capture. Laser iridotomy prevented recurrence of reverse pupillary block and pupil capture. Widening of the gap between the inner and outer flaps of the scleral tunnel during reverse pupillary block was seen on AS-OCT in 2 eyes; the widening was associated with wound leakage in 1 eye. Conclusion Anterior segment OCT showed that reverse pupillary block can occur in eyes with scleral-fixated sutured PC IOLs and cause postoperative pupil capture and scleral tunnel insufficiency.