No, it is definitely not. On this picture you will see one in a 70 year old lady, who underwent a complications free MSICS with massive pseudoexfoliations and miotic pupil.
Pupillotomy is an excellent method for defusing a potential bomb during MSICS with narrow pupils when:
1) mechanical stretching of the pupil has not yielded any results (e.g., in PEX),
2) iris hooks or a Malyugin ring are not available,
3) additional risks, such as a wrinkled fibrous capsule or a very large nucleus, are present.
At that time (and up to date) I couldn’t find a better solution. By the way, it’s a fairly mature MSICS, with several hundred operations under my belt.
After patients had been living with just a perception of light, this cosmetic issue didn’t matter to them. A complication-free surgery in situations where such complications would be nearly impossible to fix far outweighs any cosmetic concerns. Interestingly, the remaining sphincter still works somehow π β The pupil even reacts a little.
P.S. At the 1 o’clock position, there is hyperpigmentation, which often occurs during the healing of a conjunctival wound in patients with racial melanosis. A year 2016.
ΠΠΎΠ»Π»Π΅Π³ΠΈ, ΡΡΠΎ ΠΊΠΎΠ½Π΅ΡΠ½ΠΎ ΡΠ°Π·ΡΠ΅Π·Π°Π½Π½ΡΠΉ Π² Π΄Π²ΡΡ
ΠΌΠ΅ΡΡΠ°Ρ
Π·ΡΠ°ΡΠΎΠΊ. ΠΡΠΏΠΈΠ»Π»ΠΎΡΠΎΠΌΠΈΡ – ΡΠΈΠΊΠ°ΡΠ½Π΅ΠΉΡΠΈΠΉ ΠΌΠ΅ΡΠΎΠ΄ ΠΎΠ±Π΅Π·Π²ΡΠ΅ΠΆΠΈΠ²Π°Π½ΠΈΡ ΠΏΠΎΡΠ΅Π½ΡΠΈΠ°Π»ΡΠ½ΠΎΠΉ Π±ΠΎΠΌΠ±Ρ Π΄Π»Ρ MSICS (Π΄Π° ΠΈ Π΄Π»Ρ ΡΠ°ΠΊΠΎ Π² ΠΎΠ±ΡΠ΅ΠΌ-ΡΠΎ, ΠΏΡΠΈ ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²ΡΡΡΠΈΡ
ΡΡΠ»ΠΎΠ²ΠΈΡΡ
) Π½Π° ΡΠ·ΠΊΠΈΡ
Π·ΡΠ°ΡΠΊΠ°Ρ
, ΠΊΠΎΠ³Π΄Π°
1) ΠΌΠ΅Ρ
Π°Π½ΠΈΡΠ΅ΡΠΊΠΈΠΉ ΡΡΡΠ΅ΡΡΠΈΠ½Π³ Π·ΡΠ°ΡΠΊΠ° Π½ΠΈ ΠΊ ΡΠ΅ΠΌΡ Π½Π΅ ΠΏΡΠΈΠ²ΡΠ» (Π½Π°ΠΏΡΠΈΠΌΠ΅Ρ, ΠΏΡΠΈ ΠΠΠ‘)
2) ΡΠ°Π΄ΡΠΆΠ½ΡΡ
ΠΊΡΡΡΠΊΠΎΠ² ΠΈΠ»ΠΈ ΠΊΠΎΠ»ΡΡΠ° ΠΠ°Π»ΡΠ³ΠΈΠ½Π° Π² Π½Π°Π»ΠΈΡΠΈΠΈ Π½Π΅Ρ
3) Π° Π΄ΠΎΠΏ. ΡΠΈΡΠΊΠΈ (Π½Π°ΠΏΡΠΈΠΌΠ΅Ρ, Π² Π²ΠΈΠ΄Π΅ ΠΌΠΎΡΡΠΈΠ½ΠΈΡΡΠΎΠΉ ΡΠΈΠ±ΡΠΎΠ·ΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠΉ ΠΊΠ°ΠΏΡΡΠ»Ρ ΠΈΠ»ΠΈ ΠΎΡΠ΅Π½Ρ ΠΊΡΡΠΏΠ½ΠΎΠ³ΠΎ ΡΠ΄ΡΠ° ΠΈΠ»ΠΈ ΠΎΡΠ΅Π½Ρ ΠΏΠ»ΠΎΡΠ½ΠΎΠ³ΠΎ ΡΠ΄ΡΠ°) – Π² Π½Π°Π»ΠΈΡΠΈΠΈ.
ΠΡΡΡΠ΅Π³ΠΎ ΡΠ΅ΡΠ΅Π½ΠΈΡ Ρ ΡΠΎΠ³Π΄Π° Π½Π΅ Π½Π°ΡΡΠ». ΠΠ° ΠΈ ΠΏΠΎ ΡΠ΅ΠΉ Π΄Π΅Π½Ρ Π½Π΅ Π·Π½Π°Ρ. ΠΡΠΎ, ΠΊΡΡΠ°ΡΠΈ, Π²ΠΏΠΎΠ»Π½Π΅ ΡΠ΅Π±Π΅ Π·ΡΠ΅Π»ΡΠΉ MSICS Ρ Π½Π΅ΡΠΊΠΎΠ»ΡΠΊΠΈΠΌΠΈ ΡΠΎΡΠ½ΡΠΌΠΈ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΉ Π·Π° ΡΠΏΠΈΠ½ΠΎΠΉ.
ΠΠΎΡΠ»Π΅ ΡΠΎΠ³ΠΎ, ΠΊΠ°ΠΊ ΠΏΠ°ΡΠΈΠ΅Π½ΡΡ ΠΆΠΈΠ»ΠΈ Π² ΠΎΡΡΡΠ΅Π½ΠΈΠΈ ΡΠ²Π΅ΡΠ°, ΠΈΠΌ ΡΡΠ° ΠΊΠΎΡΠΌΠ΅ΡΠΈΡΠ΅ΡΠΊΠ°Ρ ΠΏΡΠΎΠ±Π»Π΅ΠΌΠ° Π½Π΅ Π²Π°ΠΆΠ½Π°. Π€ΡΠ½ΠΊΡΠΈΠΎΠ½Π°Π»ΡΠ½Π°Ρ ΠΏΡΠΎΠ±Π»Π΅ΠΌΠ° Π½Π° Π°ΡΡΠΈΡΠ°ΠΊΠΈΡΠ½ΠΎΠΌ Π³Π»Π°Π·Ρ – Π½ΠΈΡΡΠΎΠΆΠ½Π°. Π ΠΎΠΏΠ΅ΡΠ°ΡΠΈΡ, ΠΏΡΠΎΠ²Π΅Π΄ΡΠ½Π½Π°Ρ Π±Π΅Π· ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ ΡΠ°ΠΌ, Π³Π΄Π΅ ΡΡΠΈ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΡ ΠΏΠΎΡΠΈΠ½ΠΈΡΡ ΠΏΡΠ°ΠΊΡΠΈΡΠ΅ΡΠΊΠΈ Π½Π΅Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎ, – ΠΏΠ΅ΡΠ΅Π²Π΅ΡΠΈΠ²Π°Π΅Ρ ΡΡΡ ΠΊΠΎΡΠΌΠ΅ΡΠΈΠΊΡ Π² ΡΠ°Π·Ρ. Π ΠΎΡΡΠ°ΡΠΊΠΈ ΡΡΠΈΠ½ΠΊΡΠ΅ΡΠ° ΠΊΡΡΠ°ΡΠΈ ΠΊΠ°ΠΊΠΈΠΌ-ΡΠΎ ΠΎΠ±ΡΠ°Π·ΠΎΠΌ ΡΠ°Π±ΠΎΡΠ°ΡΡ:) – ΠΡΠΎΡ Π·ΡΠ°ΡΠΎΠΊ ΡΡΡΠΎΡΠΊΡ ΠΈΠ³ΡΠ°Π΅Ρ.
ΠΡΠ΅Π³Π΄Π° ΡΠ΄ΠΈΠ²Π»ΡΠ»ΠΎ, ΡΡΠΎ Π½ΠΈΠΊΠ°ΠΊΠΎΠ³ΠΎ ΠΊΡΠΎΠ²ΠΎΡΠ΅ΡΠ΅Π½ΠΈΡ ΠΏΡΠΈ ΠΏΡΠΏΠΈΠ»Π»ΠΎΡΠΎΠΌΠΈΠΈ, ΠΏΠ΅ΡΠ΅ΡΠ΅Π·Π°ΡΡΠΈΠΉ ΠΌΠ°Π»ΡΠΉ ΡΠΎΡΡΠ΄ΠΈΡΡΡΠΉ ΠΊΡΡΠ³ ΡΠ°Π΄ΡΠΆΠΊΠΈ, – Π½Π΅ Π½Π°Π±Π»ΡΠ΄Π°Π».
Π.Π‘. Π½Π° 1 ΡΠ°ΡΠ΅ Π³ΠΈΠΏΠ΅ΡΠΏΠΈΠ³ΠΌΠ΅Π½ΡΠ°ΡΠΈΡ, ΠΊΠΎΡΠΎΡΠ°Ρ ΡΠ°ΡΡΠΎ Π±ΡΠ²Π°Π΅Ρ ΠΏΡΠΈ Π·Π°ΠΆΠΈΠ²Π°Π½ΠΈΠΈ ΠΊΠΎΠ½ΡΡΠ½ΠΊΡΠΈΠ²Π°Π»ΡΠ½ΠΎΠΉ ΡΠ°Π½Ρ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΡΠ°ΡΠΎΠ²ΡΠΌ ΠΌΠ΅Π»Π°Π½ΠΎΠ·ΠΎΠΌ. 2016 Π³ΠΎΠ΄.
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