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• W2025432888 abstract "We congratulate Sridhar and Raber on their well-described method of pupilloplasty.1 Not only fixed and dilated pupils but also irregular pupils due to complete iridectomy are bothersome, particularly in eyes that have keratoplasty. However, the article raises several queries in my mind. First, the indication for penetrating keratoplasty (PKP) is not clear. Second, it is mentioned that there was a central midstromal scar for which an 8.5 mm recipient window was created, but the exact size was not emphasized. A best corrected visual acuity (BCVA) of 20/40 in the presence of a corneal scar indicates that the size of the opacity was not big enough to necessitate a large window of 8.5 mm. The authors further mention that the 8.5 mm recipient window was designed for easy access and to preserve the quality of the nonperipheral graft. But in clinical experience, an apparently small window is good enough for the pupilloplasty. A large recipient window in this particular patient is prone to acquire 2 risk factors: The size of the graft has a direct correlation on the outcome, and it has a higher chance of rejection. Recurrence of the initial disease, although it has no direct correlation with the size of the graft, is an important consideration in an eye with viral keratitis. Moreover, the decision of selecting the size of the repeat graft, if required in the future, becomes difficult. It is also not clear whether the photophobia was due to the dilated pupil or to ocular surface irregularities. Also, 360-degree suturing of the iris precludes future dilation. Instead, a small 10-0 polypropylene suture along an arc of the pupil in eyes with prior optical iridectomy might have worked similarly to achieve a round pupil (Figure 1) 2 and still preserved the dilatability of the pupil (if it existed). The same would not have necessitated a large window. Furthermore, we assume the postoperative BCVA of 20/50 from the preoperative BCVA of 20/40 is a typographical error.Figure 1.: (Panda) Pupilloplasty in keratoplasty with multiple areas of iris atrophy.Finally, I would like to congratulate the authors for emphasizing the role of pupilloplasty during keratoplasty (to achieve a round pupil on the table) to enhance graft survival and thus enhance a good visual outcome.2 Anita Panda MD, FICS, MRC(Ophth) Mayank S. Pangtey MD Parul Sony MD New Delhi, India" @default.
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• W2025432888 date "2002-11-01" @default.
• W2025432888 modified "2023-09-25" @default.
• W2025432888 title "Open-Sky Pupilloplasty To Treat Fixed, Dilated Pupil" @default.
• W2025432888 cites W2030743797 @default.
• W2025432888 doi "https://doi.org/10.1016/s0886-3350(02)01791-1" @default.
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