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Iris Posterior Synechiae After Descemet Membrane Endothelial Keratoplasty in Asian Eyes

Prevention and Management of Posterior Synechiae

Kobashigawa, Yuji M.D.; Shimizu, Toshiki M.D.; Hayashi, Takahiko M.D., Ph.D.; Kobashigawa, Hiroko M.D.; Yuda, Kentaro M.D., Ph.D.; Mizuki, Nobuhisa M.D., Ph.D.; Yamada, Norihiro M.D., Ph.D.; Kato, Naoko M.D., Ph.D.

doi: 10.1097/ICL.0000000000000616
Article: PDF Only

Objectives: To evaluate the efficacy of a mydriatic agent for posterior synechiae after phacoemulsification and intraocular lens (IOL) implantation followed by Descemet membrane endothelial keratoplasty (staged DMEK).

Methods: In this prospective study, the outcomes of DMEK with or without mydriasis (0.5% tropicamide and 0.5% phenylephrine hydrochloride [Mydrin-P; Santen, Osaka, Japan]) after the DMEK procedure were analyzed. Patients underwent IOL implantation approximately 4 weeks before DMEK. Six months after DMEK, the iris posterior synechiae severity score was evaluated based on the extent of posterior synechiae affecting the eight areas (45° each) of the pupillary rim (posterior synechiae score; grades 0–8). Best spectacle-corrected visual acuity, central corneal thickness, endothelial cell density, axial length, and the amount of air at the end of the surgery were also evaluated.

Results: Fifteen eyes of 15 patients (mydriatic: n=8, control: n=7) were eligible for inclusion. Iris posterior synechiae were detected in all seven eyes (100.0%) in the control group, whereas they were noted in two eyes in the mydriatic group (25%). The mean iris posterior synechiae score was 0.69±1.20 in the mydriatic group and was significantly lower than that in the control group (4.57±0.90; P<0.001). There was no significant difference in other clinical factors. Although the incidence and scores of posterior synechiae in the control group were higher, the incidence was significantly reduced with the use of a mydriatic agent (in the mydriatic group).

Conclusions: Use of a mydriatic agent is an effective measure to prevent postoperative synechiae after DMEK.

Department of Ophthalmology (Y.K., T.H., and H.K.), Yokohama Minami Kyosai Hospital, Yokohama, Japan; Department of Ophthalmology (Y.K., T.S., T.H., H.K., K.Y., N.M., and N.Y.), Yokohama City University Hospital, Yokohama, Japan; Department of Ophthalmology (T.H.), Jichi Medical University, Tochigi, Japan; and Department of Ophthalmology (N.K.), Saitama Medical University, Saitama, Japan.

Address correspondence to Takahiko Hayashi, M.D., Ph.D., Yokohama Minami Kyosai Hospital, 1-21-1, Mutsuura Higashi, Kanagawa, Yokohama 236-0037, Japan; e-mail:

The authors have no funding or conflicts of interest to disclose.

Y. Kobashigawa and T. Shimizu contributed equally to this work.

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Accepted March 31, 2019

© 2019 Contact Lens Association of Ophthalmologists, Inc.