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Iridotomies on eyes with uveitis: indications and technique
  1. Gary N Holland1,
  2. Keith Barton2
  1. 1UCLA Stein Eye Institute, Los Angeles, California, USA
  2. 2Moorfields Eye Hospital, London, UK
  1. Correspondence to Dr Gary N Holland, UCLA Stein Eye Institute, 100 Stein Plaza, Los Angeles, CA 90095-7000, USA; uveitis{at}jsei.ucla.edu

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Posterior synechiae are common complications of anterior uveitis, and can result in pupillary seclusion, iris bombé and angle-closure. In this issue of the journal, Betts and associates1 describe their experience in managing such patients. Despite the limitations of a non-randomised, retrospective study, their results support the assumption of many uveitis and glaucoma experts that patients with uveitis whose disease is complicated by iris bombé from extensive posterior synechiae should have surgical iridectomies rather than laser iridotomies. The authors’ patients who were managed surgically had a markedly lower risk of treatment failure. Why the difference in outcomes? Laser iridotomies may stimulate more inflammation than surgical iridectomies, causing an outpouring of fibrin from the laser iridotomy site, which will eventually close the small, irregular opening. In contrast, surgical iridectomies are larger; with sharp, well-defined edges; and they tend to be more peripheral, all factors reducing the risk that the opening will scar closed.

Inflammation at the time of the iris procedure was not identified as a significant risk factor for failure in the current authors’ series, …

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