![]() The disadvantages of a small pupil include a greater risk of complications retained cortex, which can lead to inflammation and create a nidus for infection and capsular phimosis. If they do not or if the iris is extremely flaccid, however, then I prefer to place a Malyugin Ring, which gives eight points of contact compared with the four or five from iris hooks and which decreases the risk of iris bombé and iris incarceration into wounds. Both viscoelastics will maintain the pupillary diameter. When the pupil’s size is maintained, the OVDs remain in the eye with a low bottle height and aspiration flow rates of 25 mL/min or less. In eyes with IFIS, the main problems occur with high aspiration flow rates and with high inflow. In my experience, Healon5 (Abbott Medical Optics Inc.) and Discovisc (Alcon Laboratories, Inc.) are especially useful for small pupils. It is essential to understand the various properties of the different viscoelastics (cohesive vs dispersive vs adaptive). When the injections are used in conjunction with OVDs, the surgeon can manage most cases of IFIS. The intracameral injections by themselves will often open the pupil enough for cataract surgery to proceed. The tools for managing small pupils include preservative-free intracameral solutions such as epi-Shugarcaine (3 mL preservative-free lidocaine 4%, 4 mL preservative- and bisulfite-free 1:1,000 epinephrine, and 9 mL BSS Plus ), ophthalmic viscosurgical devices (OVDs), iris hooks, and iris rings. SURGICAL PLANNINGĪs always, the surgical plan should include backup strategies for the different etiologies. IFIS presents its own surgical challenges (see the article on page 41 by Samuel Masket, MD). The goal is to decrease the risk of capsular phimosis, which may be a factor in late, spontaneous subluxation of the IOL-capsular bag complex. It is important to enlarge the pupil enough to permit the creation of an appropriately sized (5.5 mm) capsulorhexis so that the surgeon can use devices to stabilize the capsule if necessary (eg, Malyugin Ring and Mackool Cataract System ). In these cases, the size of the pupil is frequently associated with the zonular problems. In addition to small pupils, the eyes of patients with PXF often exhibit brittle capsules and zonular weakness (Figure). Afterward, the pupil still may not dilate well. Patients with chronic uveitis, for example, often have posterior synechiae that must be broken mechanically (a cyclodialysis spatula or other blunt instrument will suffice). The surgical approach varies with the cause of the small pupil and the presence of comorbities (eg, glaucoma). How should cataract surgeons proceed when the pupil is small? THE CAUSE MATTERS Moreover, small pupils are quite common in patients who are taking α-1 inhibitors and/or nutritional supplements that contain saw palmetto to treat an enlarged prostate, and these therapies can induce intraoperative floppy iris syndrome (IFIS). They also occur in patients with pseudoexfoliation (PXF) syndrome, uveitis, narrow-angle glaucoma, and diabetes. Small pupils are found among the elderly. The result can be increased inflammation, Soemmering rings, and possibly capsular phimosis. Although modern cataract techniques, especially chopping techniques, allow surgeons to consider removing a cataract without enlarging the pupil, the complication rate is higher when the pupil remains small, and completing the cortical cleanup may be problematic. Investing in New Devices for Cataract SurgeryĪ number of situations require the management of a small pupil. What to Do When Customers Criticize You Online ![]() The Impact of Mergers and Acquisitions on Industry’s Relationship With Ophthalmologists Sidebar: Are Changes to the CE Marking Process Imminent? Pharmacologic Approaches to the Small Pupil The Ocular Surface: Where Research Meets and Greets BusinessĬataract Surgery in an Eye With Blunt Trauma, Glaucoma, and Zonular WeaknessĪ Healthy Tear Film Equals a Happy PatientĬataract Surgery On Eyes With Small Pupils
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |