Safety and efficacy of phacoemulsification and intraocular lens implantation through a small pupil using minimal iris manipulation

Figures & data

Figure 1 Intraoperative small hemorrhages during manual dilation of small pupil.

Figure 2 Small iris sphincter ruptures.

Table 1 Patient demographics

	Group I (small pupil)	Group II (controls)
No of patients	78	45
Maximally dilated (with only	≤4 mm	≥7 mm
mydriatic drops) pupil size
Age (years), mean (±SD)	72.69 (±6.58)	71.84 (±6.73)
Range	58–87	59–84
Sex
Male	40	22
Female	38	23
Causes of small pupil
Pseudoexfoliation syndrome	46
Previous glaucoma surgery	11
Glaucoma (open angle or angle closure)	14
Posterior synechiae with iritis	7

Table 2 Group I mean pupil size

	Preoperatively (after mydriatic drops)	After viscoelastic and mechanical pupil dilation	End of surgical procedure
Pupil size (mm)	3.2	4.3	4.1

Table 3 Corneal edema and iritis/anterior chamber flare at the first postoperative day and BCVA on the 30th postoperative day

	Group I	Group II
Corneal edema	Grade 0, 13 patients	Grade 0, 9 patients
	Grade 1, 39 patients	Grade 1, 26 patients
	Grade 2, 21 patients	Grade 2, 10 patients
	Grade 3, 5 patients	Grade 3, 2 patients
Mean (±SD)	1.23 (±0.80)	1.17 (±0.80)
Iritis/anterior chamber flare	Grade 0, 16 patients	Grade 0, 7 patients
	Grade 1, 42 patients	Grade 1, 32 patients
	Grade 2, 19 patients	Grade 2, 6 patients
	Grade 3, 1 patient
Mean (±SD)	1.06 (±0.70)	1.00 (±0.50)
BCVA, mean (±SD) (Monoyer’s scale)	8/10 (1.49)	8.1/10 (1.5)

Abbreviation: BCVA, best-corrected visual acuity.

Figure 3 Comparison of postoperative corneal edema between the two groups, P=0.92.

One month after surgery, the pupils were round and reactive to light; the anterior chambers were quiet; and the corneas were clear in all studied eyes. The BCVA on Snellen chart was 20/40 (Monoyer’s scale) or better and there were no statistically significant differences between the two groups (Figures 3–6).

Figure 4 Comparison of postoperative iritis between the two groups, P=0.25.

Abbreviation: ac, anterior chamber.

Figure 5 Comparison of postoperative VA between the two groups, P=0.32.

Abbreviations: BCVA, best-corrected visual acuity; VA, visual acuity.

Figure 6 Comparison of postoperative IOP between the two groups, P=0.11.

Abbreviation: IOP, intraocular pressure.