LASER SURGERY OF THE PAPILLARY BLOCK IN THE CHILDREN

The results of 163 YAG-laser interventions for the elimination of the papillary block following the extraction of congenital, traumatic, complicated, and secondary cataracts are reported. Basal colomba was present in all treated eyes after YAG-laser iridectomy and iris bombe was eliminated in 93,9% of the children. The papillary block was eliminated with the complete restoration of normal anatomical features in 65,5% of the patients in the immediate postoperative period (within 3 months after surgery) and in 54,9% during the follow-up period from6 months to 17 years in duration with the partial restoration of anatomical and morphological relationships in the affected region in one third of the children (32,5% and 35,3% respectively). The hypotensive effect was documented in 96,6% and 85,3% of the children in the early and late postoperative periods respectively. It was shown that indications for the elimination of the papillary block include any variants of clinical manifestations of this pathology, such as seclusion of the pupil, iris bombe (both with ophthalmic hypertension (requiring emergency intervention) and without it (threatening iridocorneal adhesions)), and preangular block (planned treatment). The strategy for the choice of the laser-assisted treatment is recommended with special reference to various clinical manifestations of the papillary block in the children. The most persistent anatomical effect characterized by the reduced frequency of hemorrhagic complications at lower energy consumption was achieved with the use of the combined Ar-YAG-laser iridectomy (in comparison with YAG-laser iridectomy) in the case of laser colomba over 1 mm in diameter. The importance of maintaining the minimal energy regime is emphasized in conjunction with taking into consideration the degree of child’s communicativeness, the possibility of surgical intervention without narcosis (usually by performing surgery in several steps), and the reduction of the number of narcotization procedures. It is concluded that YAG-laser iridectomy provides an effective and safe tool for the elimination of the pupillary block as an alternative to surgical iridectomy; moreover, it does not require repeated capsulotomy and can not infrequently be performed possible without narcosis.

YAG-laser, laser surgery, pediatric ophthalmology, papillary block