Iris Fixation via External Pentagram Suturing

The pentagram suturing anterior chamber plasty, or PSACP, provides an adequate space basis for DSAEK to help cure the bullous keratopathy caused by a vanished anterior chamber or extensive anterior synechia. Begin by displaying the range of anterior synechia by ASOCT and UBM to design the position of incisions. Mark the five scleral puncture points 1.5 millimeters posterior to the limbus with 1%crystal violet solution.

After ensuring that the circular distance between the adjacent puncture points is 72 degrees, remove the edematous epithelium of the cornea with a sclera tunnel knife. Make a one millimeter limbus incision and inject cohesive viscoelastic to separate the anterior synechia of the iris. Perform blunt separation for PAS.

Insert the 16 millimeter STC-6 needle one millimeter beside one of the puncture points into the anterior chamber and retrieve it across the surface of the iris within the bore of a 29 gauge syringe from another puncture point with a circular distance of 144 degrees. When the STC-6 needle comes out of the anterior chamber, select the next insertion point. Repeat this process until the retention sutures in the anterior chamber form a pentagram-like barrier on the surface of the iris and pupil.

Tie a surgical knot from the initial insertion point and embed it into the superficial sclera under the bulbar conjunctiva. In the first case study without PSACP one day post-anterior chamber plasty with synechia separation and PKP, the 68-year-old female showed no PAS with the ASOCT and BCVA improved to 20/1000 with elevated IOP. 12 weeks after surgery, the patient showed 360 degrees PAS with the UBM and BCVA decreased to 20/1600.

The IOP was uncontrolled over 25 millimeters of mercury and the bullous keratopathy reoccurred. In the second case study, a 75-year-old female received PSACP where pentagram sutures were placed as a barrier in front of the anterior surface of the iris. No PAS was seen with ASOCT or UBM until 12 weeks post-surgery.

In 24 weeks post DSAEK and PSACP, no corneal edema was observed and one clock hour PAS was demonstrated with UBM, with BCVA 20/66. IOP remained normal without any medication post-surgery. In the third case study, a 69-year-old female received PSACP and showed two clock hours PAS with ASOCT on day one post-surgery.

The patient showed six clock hours PAS with UBM in 24 weeks post-surgery and received PKP. On one week post PKP, mild edema was seen in the cornea graft and six clock hours PAS with the ASOCT with improved BCVA 20/400. IOP remained normal without any medication post-surgery.

Ensure that the adjacent puncture points are at a circular distance of 72 degrees and that puncture points are 1.5 millimeters posterior to the limbus without touching the anti-glaucoma filtration bleb. Iris fixation via PSACP utilizes only one 10-0 proline suture to form a stable anterior chamber with adequate spaces for over a month. This can be followed up with DSAEK or PKP for treating bullous keratopathy with extensive anterior synechia of the iris.