Posters

Management of small pupil in phacoemulsification and manual small incision cataract surgery

Poster Details

First Author: U.Gadgil INDIA

Co Author(s):    M. Chaugule                    

Abstract Details

Purpose:

To study the efficacy of various interventions in cases with small pupil during phacoemulsification and manual small incision cataract surgery. Interventions used were intracameral mydriatics,viscomydriasis,iris stretching with Kuglen hooks,Malyugin ring and Assia's pupil expander in cases of small pupil .The aetiologies of small pupil were varied like Intraoperative floppy iris syndrome( IFIS) pseudoexfoliation,chronic uveitis,chronic use of topical miotics.

Setting:

Dr Gadgil eye clinic and hospital, Thane, Maharashtra, India

Methods:

30 patients with small pupil not dilating beyond 5mm with topical mydriatic were included in the study.Of these 10 patients had pseudoexfoliation(PXF) ,9 patients had IFIS syndrome,6 patients had chronic uveitis,2 patients had pupillary membrane,1 patient was having long term miotic use, 2 patients had unknown cause.5 patients underwent manual small incision cataract surgery and 25 patients underwent phacoemulsification . All patients were operated under peribulbar anesthesia. For all the cases extensive preoperative preparation with intracameral mydriatics,pupil stretching devices like kuglen hooks, iris hooks and pupil expansion devices like Malyugin ring and Assia pupil expander were kept ready.

Results:

In cases with pseudoexfoliation 3 patients required viscomydriasis ,2 patients required intracameral mydriatic , 3 patients iris hooks and 2 cases required Malyugin ring for pupillary dilatation.In cases with IFIS syndrome 5 patients required Malyugin ring and 3 patients required Assia pupil expander combined with iris hooks at wound site.In cases with uveitis mechanical stretching of pupil and synechiolysis with visco cannula or blunt dissection was done. In cases with pupillary membrane membranectomy was done.In patient with preoperative miotic use Kuglen hook and viscomydriasis was required.In patients with unknown cause 1 patient required viscomydriasis and 1 required intracameral mydriatic.

Conclusions:

In patients with pupillary dilation between 3.5-5mm adequate pupillary dilation was achieved with viscomydriasis and intracameral mydriatic(preservative free epinephrine+ lignocaine).In patients with pupillary dilatation less than 3.5mm mechanical stretching with kuglen hooks ,iris hooks and pupil expansion devices like Malyugin ring ,Assia pupil expander were required.Most difficult cases were patients with IFIS syndrome due to loose muscle tone which lead to billowing of iris and iris prolapse which was prevented by combined approach of Malyugin ring and iris hooks at wound site.In small incision cataract surgery cases larger pupil size(>5.5mm) was required for prolapse of nucleus into anterior chamber.

Financial Disclosure:

None