Title: Case of Epithelial Ingrowth After Cataract Surgery Treated with Argon Laser and Monitored by Fourier
1 Case of Epithelial Ingrowth After Cataract Surgery Treated with Argon Laser and Monitored by Fourier Domain Optical Coherence Tomography Jin Pyo HongMD1 Jae Lim ChungMD1 Jung Won ParkMD2 Tae-im KimMDPhD1 Kyoung Yul SeoMDPhD1 Eung Kweon KimMDPhD1
1Department of Ophthalmology Yonsei University College of Medicine Seoul Korea
2Daegu Yonsei Eye Clinic Daegu Korea
Authors have no financial interest 2 Purpose
To report the development of epithelial ingrowth after cataract surgery with simultaneous removal of persistent pupillary membrane and effectiveness of argon laser as treatment modality RTVue-100 (Fourier domain optical coherence tomography) as monitoring tool.
54 year old female came to our clinic for decreased visual acutiy
20/200(OD) 20/400(OS) for uncorrected visual acuity (UCVA)
20/25(OD) 20/50(OS) for best corrected visual acuity (BCVA)
13mmHg(OD) 14mmHg (OS)
Slit lamp microcopy
Persistent pupillary membrane with moderate cataract(OU)
Surgery of left eye
Persistent pupillary membrane was removed with Banna scissors and Healon after 3mm temporal incision.
Extraction of cataract was followed through 3mm incision.
Postoperative 1 day
20/200(OS) for UCVA 14 mmHg (OS) for IOP
Ciprofloxacin and prednisolone 1 were used.
Postoperative 3 month
0.8(OS) for BCVA 20 mmHg(OS) for IOP
Postoperative 3 month
IOP was increased to 56 mmHg (OS)
Iris bombe and angle closure were found
After peripheral iridectomy IOP was decreased to 7 mmHg (OS)
Even after first iridectomy because the angle closure and high IOP was repeatedly observed total 4 more iridectomies had been performed.
Postoperative 8 month
IOP was increased to 64 mmHg (OS) UCVA was less than 20/400
Epithelial ingrowth was observed at whole iris surface(arrows) and easily diagnosed with RTVue-100 Fourier domain OCT.
Postoperative 8 month
RTVue-100 Fourier domain OCT was performed
Normal iris surface with hyperreflection(long arrow)
Fibrotic membrane overlying the iris surface with less reflective than iris surface (short arrow)
After applying argon laser on the epithelial ingrowth to find size of epithelial ingrowth fibrotic membrane was turned to white fluffy opaque appearance
After applying 4 more argon laser on the epithelial ingrowth the regression of fibrotic membrane was found
After 2 more argon laser treatment
After 4 more argon laser treatment
Fibrotic membrane was found to be seperated from iris surface(arrows)
After a few more argon laser treatment the clearance of fibrotic membrane was found.
No complications was reported during argon laser treatments recurrence have not been found hereafter
UCVA was increased to 20/40
We inferred that
Release of proinflammatory factors into anterior chamber from incised iris
Epithelial ingrowth might be developed more easily by this factors
A good tool for diagnosis and monitoring for epithelial ingrowth
Especially in case of ambiguous epithelial ingrowth
Argon laser photocogluation
Effective modality as not only to detect but also to treat the epithelial ingrowth in this case
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