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Management of Reverse Pellucid Type Topography

Çakir, Hanefi, M.D.; Utine, Canan Asli, M.D., M.Sc.

doi: 10.1097/ICL.0000000000000423

Purpose: Evaluation of the etiopathogenesis and management of topographic reverse pellucid pattern after rigid intraocular lens (IOL) implantation with wide limbal clear corneal incision (CCI).

Methods: Fifteen eyes with a history of gradual decrease in vision after IOL surgery with at least 6.5-mm CCI were diagnosed with wound dehiscence and were managed with tight resuturation, delayed, and selective suture removal. The improvement in uncorrected and corrected distance visual acuities (UDVA and CDVA, respectively) and refractive errors were analyzed, at least 6 months postoperatively.

Results: Postoperatively, UDVA improved in 13/15 eyes (86.7%), whereas CDVA also improved for at least 2 Snellen lines in 11/15 eyes (73.3%) (P<0.01 for both). In all patients, against-the-rule astigmatism changed to with-the-rule astigmatism pattern and the amount of cylinder decreased as the sutures are removed progressively. Vector analysis of astigmatism showed an arithmetic mean of corrected amount of cylinder of 4.17±2.10 D using manifest refraction data and 4.90±2.83 D using keratometric data at the last follow-up.

Conclusion: Low visual acuity together with high astigmatism after rigid IOL surgery should prompt the surgeon for considering wound dehiscence that could be managed by careful and deliberate wound revision.

Department of Ophthalmology (H.C.), Turkiye Hospital, Istanbul, Turkey; and Department of Ophthalmology (C.A.U.), Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.

Address correspondence to Canan Asli Utine, M.D., M.Sc., Department of Ophthalmology, Faculty of Medicine, Dokuz Eylul University, Mithatpasa cad. No:1606 Inciralti Kampusu, Balcova, Izmir 35340, Turkey; e-mail:

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

Accepted July 15, 2017

© 2018 Contact Lens Association of Ophthalmologists, Inc.