Whether an ophthalmologist prefers a broad basal iridectomy (keyhole) or the peripheral iridectomy or iridectomies (round-pupil) depends in a large part upon where he is practicing and where he received his training. However, a keyhole iridectomy is usually the choice in eyes where an old uveitis exists or in those cases where pupillary dilatation is poor. There is another category in which a broad basal iridectomy is considered essential by some ophthalmologists. That is, in cases where the first eye developed a retinal detachment or pupillary block glaucoma from vitreous herniation.
The reasons for maintaining the round pupil are, as we all know, as follows:
There is a more perfect optical system, said by some to be more physiologic, with resulting (a) less glare, (b) less astigmatism, (c) better depth of field.
It is cosmetically more pleasing.
There is less chance of vitreous loss.
There is more effective use of
JOHNSON DS, PINO RH. Keyhole and Peripheral Iridectomies in Different Eyes in the Same Patient. AMA Arch Ophthalmol. 1957;58(3):421-425. doi:10.1001/archopht.1957.00940010433017