Case of Epithelial Ingrowth After Cataract Surgery Treated with Argon Laser and Monitored by Fourier

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Case of Epithelial Ingrowth After Cataract
Surgery Treated with Argon Laser and Monitored by
Fourier Domain Optical Coherence Tomography Jin
Pyo Hong,MD1, Jae Lim Chung,MD1, Jung Won
Park,MD2, Tae-im Kim,MD,PhD1, Kyoung Yul
Seo,MD,PhD1, Eung Kweon Kim,MD,PhD1

• 1Department of Ophthalmology, Yonsei University,
  College of Medicine, Seoul, Korea
• 2Daegu Yonsei Eye Clinic, Daegu, Korea

Authors have no financial interest
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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.

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Methods

• 54 year old female came to our clinic for
  decreased visual acutiy
• Examinations
• 20/200(OD), 20/400(OS) for uncorrected visual
  acuity (UCVA)
• 20/25(OD), 20/50(OS) for best corrected visual
  acuity (BCVA)
• Intraocular pressure(IOP)
• 13mmHg(OD), 14mmHg (OS)
• Slit lamp microcopy
• Persistent pupillary membrane with moderate
  cataract(OU)

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Methods

• 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

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Methods

• 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.

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Methods

• 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.

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Methods

• 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)

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Results

• After applying argon laser on the epithelial
  ingrowth to find size of epithelial ingrowth,
  fibrotic membrane was turned to white fluffy
  opaque appearance

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Results

• 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)

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Results

• 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

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Conclusion

• We inferred that
• Release of proinflammatory factors into anterior
  chamber from incised iris
• Epithelial ingrowth might be developed more
  easily by this factors
• RTVue-100 (Fourier domain optical coherence
  tomography)
• 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