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Surgery-induced iris abnormalities after Descemet membrane endothelial keratoplasty and their impact on postoperative clinical outcomes [Letter]

Authors Srirampur A

Received 21 June 2019

Accepted for publication 10 July 2019

Published 26 July 2019 Volume 2019:13 Pages 1377—1378

DOI https://doi.org/10.2147/OPTH.S220378

Checked for plagiarism Yes

Editor who approved publication: Dr Scott Fraser

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Arjun Srirampur

 

Consultant, Anand Eye Institute, Hyderabad 500007, India

 

I have read with great interest the article by Mori et al1 on “Surgery-induced iris abnormalities after Descemet membrane endothelial keratoplasty and their impact on postoperative clinical outcomes” and I have a few concerns regarding the article.

 

View the original paper by Mori and colleagues

Dear editor

I have read with great interest the article by Mori et al1 on “Surgery-induced iris abnormalities after Descemet membrane endothelial keratoplasty and their impact on postoperative clinical outcomes” and I have a few concerns regarding the article.

Firstly, the authors should have graded the amount of iris damage on slitlamp examination. This would give more insight into the magnitude of iris damage and subsequent formation of peripheral anterior synechiae. This becomes even more important as the authors mention that no gonioscopy was performed in the study.

Secondly, it would have been more informative if the axial lengths of the eyes were mentioned as it is known that short axial lengths and iris damage are associated with iris posterior synechiae after DMEK.2 As the study population in this article is from Japanese eyes this becomes vital as Asian eyes are known to have short axial lengths and shallow anterior chamber depths.

Thirdly, the group with iris damage had less visual improvement than the group without iris damage. The amount of cystoid macular edema (CME) in the postoperative period is positively correlated to the amount of intra operative iris damage. The aqueous humor of those eyes may contain higher protein/cytokine levels, consistent with the “chronic pathological inflammation” theory which can lead to CME.3 This should been taken into account while analysing the visual outcomes in the iris damage group.

Disclosure

The author reports no conflicts of interest in this communication.

References

1. Mori N, Yokogawa H, Kobayashi A, Nishino T, Sugiyama K. Surgery-induced iris abnormalities after Descemet membrane endothelial keratoplasty and their impact on postoperative clinical outcomes. Clin Ophthalmol. 2019;13:805–809. doi:10.2147/OPTH

2. Arnalich-Montiel F, Pérez-Sarriegui A, Lauzirika G, et al. Pupillary abnormalities in Descemet membrane endothelial keratoplasty after nearly full tamponade. Cornea. 2017;36:290–294.

3. Shimizu T, Hayashi T, Yuda K, et al. Short axial length and iris damage are associated with iris posterior synechiae after Descemet membrane endothelial keratoplasty in Asian eyes. Cornea. 2018;37(11):1355–1359. doi:10.1097/ICO.0000000000001698

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