Endotherme Pupilloplastik

Objective of surgery

The aim of endothermal pupilloplasty (EP) is to optimize centering of the pupil, contour, or size.

Indications

The EP is performed in patients with congenital or acquired corectopia or an irregular pupil shape. In individual cases the technique has also been used to tighten the iris in floppy iris syndrome and to adapt iris tissue edges in patients with sectoral iris defects or iridodialysis.

Contraindications

In patients with pronounced iris stromal atrophy or major iris tissue defects, e.g., congenital or posttraumatic, EP could be indicated after careful consideration.

Surgical technique

Viscoelastic substances are injected into the anterior chamber via a 23-gauge paracentesis. Using the blunt tip of a bipolar endodiathermy probe, the iris tissue is selectively cauterized at several points, stretching the pupil in the direction to which cauterization is applied. The higher the energy level applied and the closer the cauterization is to the pupil margin, the more effect is achieved. The viscoelastic agents are suctioned off and the paracentesis is sealed by hydration (and additionally sewn in children). A video of the operation, which is available online, shows the surgical technique in detail.

Follow-up

Control examinations are recommended after 1 day, 1 week and 1–3 months post-EP. A combination of topical steroids and antibiotics, e.g., dexamethasone and gentamicin eye drops, should be applied 5 times daily for 1 week and 3 times daily for another week.

Evidence

To date, isolated positive retrospective case reports on EP have been published. There is a lack of prospective studies, reviews or meta-analyses.