Oman J Ophthalmol. 2017 Sep-Dec;10(3):220-224. doi: 10.4103/ojo.OJO_102_2016.

Causes and management of small pupil in patients with cataract.

Oman journal of ophthalmology

Ioannis Halkiadakis, Irini Chatziralli, Evangelos Drakos, Michail Katzakis, Sotirios Skouriotis, Eleni Patsea, Panagiotis Mitropoulos, Artemios Kandarakis

PMID: 29118499 PMCID: PMC5657166 DOI: 10.4103/ojo.OJO_102_2016

Abstract

BACKGROUND: The purpose of the study was to present the causes and management of small pupil (<6 mm) in Greek patients with cataract.

METHODS: About 1144 consecutive patients with cataract comprised the study group. The pupil size was measured after maximal dilation by means of Rosenbaum cards and Colvard pupillometer. Dilation regimen included phenylephrine 10%, tropicamide 1%, cyclopentolate 1%, and ketorolac trometamol 0.5% administered 3 times at 5 min intervals starting 1 h before surgery. The presence of possible risk factors for small pupil was recorded. The need of additional maneuvers and devices to dilate the pupil during cataract surgery was examined, and the complication rate in cases with small pupils was recorded.

RESULTS: Small pupil was observed in 78 out of 1144 eyes (6.8%, 95% confidence interval = 5.2%-8.8%). Nine eyes had pupil size <4 mm (0.78%) preoperatively. Six cases (0.52%) developed intraoperative pupillary miosis. The major cause of small pupil was pseudoexfoliation (PEX) in 47.4% (37/78) of patients. No significant associations were observed regarding age, gender, history of diabetes mellitus, the maturity of cataract, and phacodonesis. Techniques for small pupil management included pupil stretching in 14 cases (17.9%), use of iris hooks in 6 cases (7.7%), iris sphincter cuts in 2 cases (2.6%), and placement of a Malyugin Ring in 4 cases (5.1%). Seven eyes (9%) with small pupil had capsular rupture versus 16 eyes (1.5%) with normal dilation (

CONCLUSIONS: Small pupil is not very common in Greek population, is mostly caused by PEX, and it is associated with increased complication rate.

Keywords: Cataract surgery; pseudoexfoliation; pupillary dilation

Conflict of interest statement

References

1. J Cataract Refract Surg. 2002 Feb;28(2):283-8 - PubMed
2. Acta Ophthalmol Scand. 2007 Aug;85(5):500-7 - PubMed
3. Acta Ophthalmol (Copenh). 1974;52(5):596-602 - PubMed
4. Arch Ophthalmol. 2001 Jul;119(7):1023-31 - PubMed
5. Br J Ophthalmol. 2004 Oct;88(10):1242-6 - PubMed
6. Ophthalmology. 2011 Mar;118(3):507-14 - PubMed
7. J Cataract Refract Surg. 2002 Oct;28(10):1826-31 - PubMed
8. Acta Ophthalmol (Copenh). 1993 Dec;71(6):765-70 - PubMed
9. Ann Hum Genet. 2015 Nov;79(6):431-50 - PubMed
10. Ophthalmology. 1998 Apr;105(4):726-32 - PubMed
11. Am J Ophthalmol. 2007 Oct;144(4):511-9 - PubMed
12. Curr Opin Ophthalmol. 2015 Mar;26(2):82-9 - PubMed
13. Ann Ophthalmol (Skokie). 2007 Fall;39(3):185-93 - PubMed
14. Mol Vis. 2013 Jul 12;19:1446-52 - PubMed
15. Can J Ophthalmol. 1992 Apr;27(3):115-9 - PubMed
16. J Cataract Refract Surg. 2008 Dec;34(12):2153-62 - PubMed
17. J Cataract Refract Surg. 2000 Aug;26(8):1210-8 - PubMed
18. Acta Ophthalmol Scand. 1997 Dec;75(6):726-9 - PubMed
19. Ophthalmology. 2009 Nov;116(11):2093-100 - PubMed
20. Klin Monbl Augenheilkd. 2004 May;221(5):328-33 - PubMed
21. J Cataract Refract Surg. 2005 Apr;31(4):664-73 - PubMed
22. Eye (Lond). 2004 Jan;18(1):59-62 - PubMed
23. Curr Opin Ophthalmol. 2007 Feb;18(1):44-51 - PubMed
24. Ophthalmology. 2004 Sep;111(9):1693-8 - PubMed
25. J Cataract Refract Surg. 2006 Oct;32(10):1611-4 - PubMed
26. Klin Monbl Augenheilkd. 1997 Nov;211(5):296-300 - PubMed
27. Br J Ophthalmol. 2004 Feb;88(2):193-5 - PubMed
28. Eye (Lond). 2016 Aug;30(8):1039-44 - PubMed

Publication Types

• Journal Article