Mar 3 (edited) • General discussion
When the Pupil Won’t Play Along: Tackling Small Pupil Cataracts
This week’s focus: Cataract surgery in patients with small pupils — a scenario that can quickly turn routine into complex.
As we know, several patient-specific factors can make cataract surgery more technically demanding:
🔹 Sunken eye / deep orbit
🔹 Small pupil
🔹 Floppy eyelids
🔹 Hard cataract
🔹 Dislocated cataract
🔹 Loose zonules
Each of these requires anticipation, planning, and the right tools in theatre.
The featured case involves a patient who presented with a grade 3 nuclear sclerotic cataract and reduced visual acuity.
- Auto-refraction: -1.00/-0.75X55
- Visual acuity: 0.4
The patient’s pupil failed to dilate despite the administration of intracameral medications, such as Phenylephrine. We subsequently utilized a Malyugin Ring to stretch the pupil. Once the pupil was expanded, we identified pseudoexfoliation as the underlying cause of the miosis. The pupil expander allowed us to perform the surgery uneventfully, avoiding high-risk complications such as iris trauma or dropped nuclear fragments.
In addition to managing the small pupil, we accounted for the risk of a myopic surprise with the intraocular lens implant by targeting +0.25 for a distance result.
At three days post-surgery, the patient’s uncorrected visual acuity was 0.9 with a refraction of 0.00/-0.50x60 degrees.
At iSurgeon, we frequently perform complex cataract surgeries and remain prepared for all potential adverse events.
(Video is sped up at 1.5x speed)
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When the Pupil Won’t Play Along: Tackling Small Pupil Cataracts
