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A ‘methodical approach’ is best in small pupils

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LAS VEGAS — A glaucoma patient with small pupils can undergo successful cataract surgery, according to a surgeon.

Speaking at the First Annual Ocular Surgery News Symposium — Glaucoma: Improving Your Odds, John R. Samples, MD, advised attendees on how to manage patients with small pupils.

“A methodical approach is best,” Dr. Samples said. He said to minimize inflammation use “lots of Pred Forte (Allergan)” or any non-steroidal anti-inflammatory drug. Aspirin should be discontinued preoperatively. To maximize dilation, Neosynephrine 10% (Bayer) “is useful but only with close monitoring since deaths have been reported with its use,” Dr. Samples said. He added that cyclogel 2% also “is surprisingly helpful.”

Dr. Samples, who served as a course director for the meeting, said a clear corneal incision is not advisable with small pupils because it may preclude the use of a sulcus lens.

For successful stretching, Dr. Samples said he uses a Gaither collar button on one side and a Sinskey hook on the other side. These devices stretch the pupil while controlling any overexpansion, he said.