title: Neodymium:YAG pupilloplasty in pediatric aphakia.
abstract: An adequate pupillary aperture is required for accurate ophthalmoscopy and retinoscopy in pediatric aphakia. When pupillary miosis does not respond to pharmacologic dilation, optical iridectomy performed with a vitreous suction-cutting instrument under general anesthesia may be required. We report a 27-month-old aphakic child whose pupillary aperture was enlarged from 1 mm to 3.5 mm with neodymium (Nd):YAG pupilloplasty, following intramuscular sedation with meperidine, promethazine, and chlorpromazine. Removal of the laser chin rest and positioning of the patient on a table with adjustable height facilitated delivery of 140 applications at 2.5 to 4.3 mJ to the pupillary border. Levobunolol 0.5% controlled the transient posttreatment rise in intraocular pressure. We suggest that Nd:YAG pupilloplasty performed with sedation be considered as an alternative to intraocular surgery when pupillary miosis in pediatric aphakia does not respond to dilating agents.
authors.affiliation: Department of Ophthalmology, University of Minnesota, Minneapolis 55455.
authors.forename: C G
authors.initials: CG
authors.lastname: Summers
authors.forename: E J
authors.initials: EJ
authors.lastname: Holland
mesh_terms: D001035:Aphakia / Q000601:surgery*; D002387:Cataract Extraction; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007429:Intraocular Pressure; D007498:Iris / Q000601:surgery*; D053685:Laser Therapy; D002040:Levobunolol / Q000627:therapeutic use; D015877:Miosis / Q000601:surgery; D009883:Ophthalmic Solutions / Q000627:therapeutic use; D011680:Pupil
chemical_list: D009883:Ophthalmic Solutions; D002040:Levobunolol