unequal pupil size after cataract surgery

In small pupils, iris tissue is located closer to the zone of high fluidic currents, which is why it is more likely to be aspirated into the ultrasound or I/A handpiece. 2,3A commonly used concentration of epinephrine is 1:1,000 mixed 1:3 with balanced saline solution. In many cases of IFIS, intracameral injection of epinephrine or phenylephrine can simplify preoperative patient preparation and enlarge and stabilize the iris tissue, reducing the risk of complications. 1 In these patients, in which the pupil tends to be large enough initially but then experiences progressive miosis during surgery, a mechanical pupil-enlargement strategy can be utilized during the earlier steps of the surgical procedure. In cases of intraoperative floppy iris syndrome (IFIS), loss of iris tissue rigidity, even in the presence of a moderately dilated pupil, will complicate the surgical procedure by increasing the risk for the iris to be aspirated and damaged by the ultrasound needle. The pupil often dilates poorly in eyes with atrophic irises, and the significantly diminished iris tone in these eyes is unable to withstand the fluidic currents in the anterior chamber and maintain the correct position of the iris. Some surgical techniques of nucleus fragmentation, such as divide and conquer, require bigger pupils than others, such as phaco chop, for safe nucleus removal. Pupil size will have to be increased up to 4.5 to 5.5 mm for an inexperienced surgeon. Most welltrained surgeons would probably agree on using pupilexpansion devices-either iris hooks or pupil-expansion rings-in an eye with a rigid pupil smaller than 3.5 mm with a soft nucleus or smaller than 4.0 mm with a hard nucleus. What size pupil is considered small is controversial, as pupil size is relative and the definition of small small is greatly influenced by the experience of the surgeon, ocular comorbidities, and the intraoperative situation.

When faced with a patient who has insufficient pupil dilation and is scheduled for cataract surgery, there are two major points to keep in mind: (1) pupil size and (2) rigidity, or biomechanical properties, of the iris tissue. Seven Steps to Integrating Laser-Assisted Cataract Surgery Into a Refractive Practiceĥ Questions With Oliver K. Why Incorporate New Technology Into Your Practice?Įarly Adoption of Laser-Assisted Cataract SurgeryĪttributes of Laser-Assisted Cataract Surgery How Long Should You Wait to Incorporate New Technology? Cataract Surgery in Small Pupils: Choosing the Appropriate Toolīlind Chopping: Managing Small Pupils Without Pupil-Expanding DevicesĬomplications of Small-Pupil Cataract Surgery

Unequal pupil size after cataract surgery