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Indian Journal of Clinical and Experimental Ophthalmology

Comparative study of use of pharmacological agents vs mechanical stretching techniques in management of small pupil in manual small incision cataract surgery

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Author Details: DN Prakash, Swetha S, K Satish

Volume : 3

Issue : 1

Online ISSN : 2395-1451

Print ISSN : 2395-1443

Article First Page : 96

Article End Page : 101


Purpose: Manual SICS requires a well-dilated pupil for nuclear management. Cataract with small pupil causes problems during nuclear management and Capsolorrhexis. In this study we share our own experience of using pharmacological agents vs mechanical stretching methods in management of small pupil in manual small incision cataract surgery.
Aim: To compare the use of Pharmacological agents vs Mechanical Stretching methods in Management of Small Pupil in Manual Small Incision Cataract Surgery.
50 cataract patients whose pupil failed to dilate beyond 4 mm were selected and randomized into two groups. 25 patients underwent cataract surgery by using 0.1 ml of intracameral inj.Adrenaline(preservative free) and other 25 patients underwent cataract surgery by mechanical stretching of pupil(Sphincterotomy/ iris hooks). All the surgeries were performed by the same surgeon and the outcome was assessed on the basis of intraoperative mydriasis, intraoperative complications during capsulorrhexis, hydro dissection, Nucleus delivery and IOL implantation and the post-operative visual acuity, IOP and complications.
Results: Of the 25 patients, who used Intra cameral Inj.Adrenaline(Group A) intraoperative mydriasis of 8mm was achieved in 20 patients. Pupil remained small in other 5 patients of which 2 had severe Pseudo exfoliation and 2 had Posterior synechiae and 1 had Floppy Iris syndrome. There was difficulty in Capsulorrhexis and nucleus delivery in these 5 patients.
Of the 25 patients who underwent cataract surgery by mechanical stretching(Group B), pupil was expanded upto 9mm in all patients but had intraoperative complications like bleeding(40%), permanent loss of iris sphincter function(44%) and abnormal pupil shape postoperatively(28%).
Conclusions: Successful surgical outcomes may be achieved with both pharmacological agents and mechanical devices. Intra operative use of Adrenaline is easier and cost effective to maintain mydriasis in cataract cases with non-dilating pupil(4mm). Mechanical stretching though expands pupil effectively, it causes trauma to the iris and also possibly to corneal endothelium and causes permanent distortion and loss of sphincter function and also increases the duration of surgery.

Small pupil, Intracameral adrenaline, Iris hooks, Sphincterotomy