Outcomes and management of the small pupil in cataract surgery: a single center experience

Session Details

Session Title: Cataract Surgery & Glaucoma

Session Date/Time: Sunday 23/09/2018 | 14:00-16:00

Paper Time: 15:32

Venue: Room A3, Podium 1

First Author: : S.Balal UK

Co Author(s): :    J. Than   C. Gizzi   G. Nithyanandara   A. Sharma           

Abstract Details

Purpose:

Stable and adequate mydriasis lasting throughout a procedure required is required during cataract surgery. Presence of a small pupil is still considered a major challenge for cataract surgeons. Pupil expansion devices are used more commonly when there is marked intraoperative floppy iris syndrome (IFIS) or significantly smaller pupil. A number pupil manipulating interventions can be employed but little data comparing outcomes between them. Little data on Malyugin ring available but used widely.

Setting:

Moorfields Eye Hospital at Bedford, UK

Methods:

Retrospective study conducted on all cataract operations between 1/12/2009 to 31/12/2016 at a single site. Collected the following information for small pupils and large pupils: intraoperative pupil management (Intracemeral phenylephrine (PE), iris hooks (IH), Malyugin ring (MR)), co-morbidities, visual acuity (VA) outcomes, intraoperative and postoperative complications. Any complication was defined as corneal oedema, iris prolapse, atonic pupil, iris tear, posterior capsule rupture (PCR), vitreous loss, zonule dialysis, raised IOP and cystoid macular oedema (CMO). Study cohort consisted of 11,793 LPs (40% M, 60% F). 1,111 SPs (55% M, 45% F).

Results:

Any complication was 30% in SPs vs 10.5% in LPs (p<0.05). PCR was 3.2% for SPs vs 0.8% in LPs (p<0.05). Capsular tension ring (0.3% LPs vs 2.1% SPs (p<0.05)). LPs gained a mean of 0.23 logMAR vs 0.22 in SPs (p>0.05). Loss of >0.3logMAR was 2.9% SPs vs 2% LPs. For SPs: PE used alone in 21%, MR alone 20%, IH alone in 14% and combination of initial PE with either MR or IH in remaining. PCR was 1.8% with MR, 1.6% IH and 0.85% with PE. 4% had either atonic pupil or iris tear after MR vs 1.8% with IH (p<0.05).

Conclusions:

Small pupils have a higher complication rate than large pupils. Overall VA outcome is similar between groups but when complications arise, the rate of VA loss is greater in SPs. Malyugin ring had lower overall complications rate than iris hooks but greater iris trauma. PE was safest overall. A prospective controlled trial is needed to determine optimum small pupil management strategy including safety and long term complications of the various methods

Financial Disclosure:

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