Posters

A comparative study of surgical outcome using different pupil expanding devices in phacoemulsification surgery

Poster Details

First Author: L.Mohan INDIA

Co Author(s):    P. Krishnan   R. Bhat   A. Philmazan              

Abstract Details

Purpose:

Pupillary miosis during surgery or inability to dialate pupil by pharmocological agents before surgery , is challenging, and pose lot of complications like radial extension of capsulorrhexis, posterior capsular rupure, retained lens material, uveitis and iris chaffing. High prevalence of diabetes, glaucoma, pseudoexfoliation and the widespread use of drugs producing intraoperative floppy iris syndrome(IFIS) with the added responsibility of giving the best refractive correction, makes the use of pupil expanding devices in selective patients.This study analysis the surgical outcome of phacoemulsification surgery in small pupils using three types of pupil expanding devices.

Setting:

This study was conducted in Comtrust Charitable Trust Eye Hospital, Calicut,Kerala, which is a superspeciality hospital in South India

Methods:

33 eyes with small pupils < 4.5 mm diameter after all pharmacological measures to dialate pupil failed,where pupil expanding devices were used from January2013 to December2019were analysed retrospectively.All patients had ocular examination, including visual acuity,intraocular pressure,fundus examination,OCT when possible,B Scan when necessary and biometry and systemic evaluation including,diabetes, hypertension,urinary problems and cardiac diseases.Preoperative Nepafenac0.1%used on previous day, tropicamide-phenylephrine combination used 1 hour before surgery.Epinephrine 1 in 1000 solution was added to 500ml of BSS solution for intraoperative mydriasis. 14 eyes had iris hooks,14,Malyugin's ring and 5 BHex pupil expanders.They were followed up on day1,8,30,90postoperatively

Results:

33 eyes of 28 patients,19 male, 9 females aged56to79years,6 eyes had chronic uveitis with compliacated cataract and posterior synechiae,12pseudoexfoliation,9 IFIS,and 6 diabetes.24(73%) had grade 3 to 4 nuclear sclerosis.14 eyes had iris hooks used through 4 side ports,14 Malyugin rings and 5 BHex pupil expanders.All had placement before capsulorrhexis except 2 Malyugins ring which were placed after rhexis.Intraoperatively placement of Malyugins ring was easier but explantation took longer time with 5(36%) producing bleeding during.BHex ring could be placed and explanted with least trauma to the iris.Iris hooks took longest time for placement of hooks and for phacoemulsifiation and iris atrophy seen in 7(50%) of cases. Postoperatively visual outcome was comparable with mean logmar0.1

Conclusions:

Pupil expanding devices are of great help in a proper phacoemulsification procedure especially when premium lenses have to be used to avoid intraoperative and postoperative complications.Iris hooks take longer procedure time for placement and explantation of hooks and also need multiple ports to introduce th hooks and give least space for manipulation. BHexrings are useful in easy maneuvering and is costeffective though Malugins ring gives a stable larger pupil size

Financial Disclosure:

None