31 1. See Chapter 3. 2. Pilocarpine 2% every 6 hours on day before surgery and every 15 minutes starting 1 hour preoperatively to constrict pupil.
Peripheral Iridectomy
Indications
Relief of pupillary block in eyes with angle closure glaucoma
Prophylaxis in eyes with anatomy predisposing toward angle closure
Select cases of chronic or secondary angle closure glaucoma in which at least 25% of angle is not permanently closed
Aphakic or pseudophakic pupillary block
Specific indications for surgical rather than laser iridectomy:
Patient unable to cooperate with laser treatment
Poor anterior segment visualization (e.g., secondary to corneal edema)
Flat anterior chamber
Preoperative Procedure
Instrumentation
Lid speculum (e.g., Lieberman)
Sutures (4–0 silk, 9–0 silk, 7–0 and 9–0 Vicryl, or 10–0 nylon)
Wheeler or similar microsurgical knife
Fine-toothed tissue forceps (e.g., 0.12 mm Castroviejo)
Smooth-tipped forceps (e.g., Jeweler’s forceps)
Vannas or DeWecker scissors
Scarifier (e.g., Beaver #64, Grieshaber #681.01)
Microsurgical knife (e.g., Beaver #75M, Superblade)
Keratome
Westcott scissors
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