title: Pupillary Abnormalities in Descemet Membrane Endothelial Keratoplasty After Nearly Full Tamponade.
abstract: OBJECTIVE
  To describe the incidence, risk factors, and management of pupillary abnormalities after anterior chamber (AC) full air or gas tamponade in Descemet membrane endothelial keratoplasty (DMEK) without pupillary block.
  
  
  METHODS
  In this retrospective case series, clinical records of 25 patients (32 eyes) who underwent DMEK were reviewed for pupillary abnormalities and iris morphology. All patients had nearly full intracameral tamponade with air or 20% SF6 at the end of surgery without default air release postoperatively.
  
  
  RESULTS
  Pupillary abnormalities ranging from mild ovalization to mid-mydriasis were seen in 56% of the cases. These abnormalities were not related to morphometric changes in the iris volume, or in the iris dilator or iris sphincter muscle, but were probably due to posterior synechiae. Combining DMEK and cataract surgery increases by 5-fold the odds of developing this complication. Surgical revision of the posterior surface of the iris and synechiolysis reversed these pupillary abnormalities.
  
  
  CONCLUSIONS
  Nonischemic pupillary abnormalities can be seen in patients with DMEK using a nearly full air/gas tamponade in the AC after surgery despite patent iridectomy especially when combined with cataract surgery. Ensuring complete mydriasis in the immediate postoperative period and a free-floating bubble in the AC above the inferior pupillary margin may reduce its incidence.
authors.affiliation: *Cornea Unit, Ophthalmology Department, Ramón y Cajal Hospital, Madrid, Spain; and †Department Optometría, Facultad de Óptica y Optometría, Universidad Complutense de Madrid, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Arnalich-Montiel
authors.forename: Ane
authors.initials: A
authors.lastname: Pérez-Sarriegui
authors.forename: Gorka
authors.initials: G
authors.lastname: Lauzirika
authors.forename: Laura
authors.initials: L
authors.lastname: Porrua
authors.forename: José Luis
authors.initials: JL
authors.lastname: Hernández-Verdejo
mesh_terms: D000368:Aged; D000388:Air; D000867:Anterior Chamber; D057111:Descemet Stripping Endothelial Keratoplasty; D058450:Endotamponade / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D011681:Pupil Disorders / Q000453:epidemiology* / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D013459:Sulfur Hexafluoride; D041623:Tomography, Optical Coherence; D014065:Tonometry, Ocular; D014792:Visual Acuity / Q000502:physiology
chemical_list: D013459:Sulfur Hexafluoride