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Abstract #47919 Published in IGR 13-4
Mathematical and computer simulation modelling of intracameral forces causing pupil block due to air bubble use in Descement Stripping Endothelial Keratoplasty: The mechanics of iris buckling
Lockington D; Luo X; Wang H; Hill NA; Ramaesh KClinical and Experimental Ophthalmology 2011;
Background: Descement Stripping Endothelial Keratoplasty has been associated with a steep learning curve. Angle closure post Descement Stripping Endothelial Keratoplasty has been reported, either because of air posterior to the iris causing iridocorneal adhesions, or by air anterior to the iris causing pupillary block. The mechanics of floppy iris syndrome and pupil block have not been discussed. Methods: We evaluated the various forces competing within the anterior chamber via mathematical modelling and computational simulation, and considered the influence of floppy iris on pupil block glaucoma. Results: Energy formulae suggest a critical pressure value will maintain normal anterior chamber relationships, above which abnormal iris buckling may occur. This mechanical instability can be influenced intraoperatively by abnormal iris properties and intracameral forces (such as air). This critical value is lowered if the patient has a floppy iris (because of a lower elastic modulus, a mechanical measure of iris rigidity). To demonstrate this mathematical concept, a 3-D computational model was built. Simulations show that, as intracameral pressure increases, the iris ring can buckle into predictable modes of shapes. Conclusion: This model shows how iris buckling could occur with an intracameral air bubble leading to posterior iris displacement and mechanical pupil block. It also shows that abnormal iris behaviour in IFIS is consistent with the expected predicted buckling of an elastic disc. (copyright) 2011 The Authors. Clinical and Experimental Ophthalmology (copyright) 2011 Royal Australian and New Zealand College of Ophthalmologists.
D. Lockington. Tennent Institute of Ophthalmology, Gartnavel General Hospital 1053 Great Western Road, Glasgow G120, . Email: davidlockington@hotmail.com
Classification:
9.4.11.4 Glaucomas associated with corneal surgery (Part of: 9 Clinical forms of glaucomas > 9.4 Glaucomas associated with other ocular and systemic disorders > 9.4.11 Glaucomas following intraocular surgery)
9.3.1 Acute primary angle closure glaucoma (pupillary block) (Part of: 9 Clinical forms of glaucomas > 9.3 Primary angle closure glaucomas)