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Abstract #15888 Published in IGR 2-3
Phacoemulsification in eyes with a small pupil
Vasavada A; Singh RJournal of Cataract and Refractive Surgery 2000; 26: 1210-1218
PURPOSE: To evaluate the intraoperative difficulties and long-term outcome of phacoemulsification through a small pupil using minimal iris manipulation. SETTING: Iladevi Cataract and IOL Research Centre, Ahmedabad, India. METHODS: This prospective study included 30 consecutive eyes with a maximally dilated pupil size of 4.0 mm or smaller. Except for synechiolysis and occasional pupil retraction with a chopper, no iris manipulation was performed. The phacoemulsification technique included creation of a deep central space, use of a low aspiration flow rate with appropriate vacuum, step-by-step chop in situ and lateral separation of the nucleus. Patients were examined one day, one week, one and three months, and one year postoperatively. Specular microscopy was performed at one month and one year. RESULTS: Fourteen eyes had chronic iritis, 12 had glaucoma surgery, two had pseudoexfoliation, and two had a rigid pupil. The mean follow-up was 13.6 months. Eighteen eyes (60%) had hard cataract. Mean preoperative pupil size was 2.80 ± 0.75 mm (SD). Mean pupil size before the capsulorhexis was initiated was 4.42 ± 0.58 mm. The iris was bruised in ten eyes during cortex removal. Trace amounts of cortex were left in four cases. Two eyes had increased intraocular pressure in the early postoperative period. Six patients had a minimal amount of retained viscoelastic material (pseudofibrin), and two developed a sterile hypopyon. Sixteen eyes had cell deposits on the IOL surface and 12 eyes, fine uveal pigments. In two eyes with previous glaucoma surgery, and in all eyes with iritis except two, posterior synechias reformed. CONCLUSIONS: Successful phacoemulsification was done with minimal or no pupil-widening maneuvers, restoring the preoperative pupil configuration.
Dr. A. Vasavada, Iladevi Cataract/IOL Research Centre, Gurukul Road, Memnagar, Ahmedabad 380 052, India
Classification:
12.12.3 Phacoemulsification (Part of: 12 Surgical treatment > 12.12 Cataract extraction)