Pupilloplasty for Managing Silicone Oil-Induced Angle-Closure Glaucoma

Drs. Priya Narang and Amar Agarwal present how to apply the single pass 4-throw pupilloplasty technique to manage secondary angle-closure glaucoma caused by silicone oil tamponade. The problem, Dr. Narang explains, is that the tamponade can increase IOP, forcing the iris to collide with the anterior chamber angle. Using animations, they highlight the key points to the technique, which is also demonstrated in this clinical video. First, a loop is drawn from the anterior chamber, the suture is looped 4 times and then, depending on the degree of synechiae, either a 6- or 4-point traction is performed. In the first case, they introduced a fluid infusion inside the eye, removed the silicon oil and then used pupilloplasty to open the anterior chamber angles. In the second case, the silicon oil was in the anterior chamber, so they made a corneal paracentesis incision before the pupilloplasty. Peripheral pupillary stretching can help assess the amount of iris tissue to use in the procedure. Pre- and postoperative intraoperative gonioscopy and anterior segment OCT showed how the method effectively cleared the corneal tissue and opened anterior chamber angles.

For more information about this technique, watch Dr. Agarwal’s interview from AAO 2017:
Single-Pass 4-Throw Technique for Pupil Reconstruction

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