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Use tools available for difficult small pupil phaco cases
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KOLOA, Hawaii — Taking your time and using all of the tools available to you can bring greater success in phacoemulsification cases with small pupils, according to a speaker here.
“Small pupils can really make a case challenging, a case that you thought should be relatively simple,” Kendall E. Donaldson, MD, MS, said at Hawaiian Eye. “In pseudoexfoliation syndrome many of these patients have small pupils and these cases can be complicated with issues with zonules.”
Kendall E. Donaldson
For pupils starting at 8.3 mm, a 2.5-mm decrease creates a 50% reduction in operative field for the surgeon, Donaldson said. A 2.5-mm reduction in a 6-mm pupil results in a 66% reduction in operative field.
Donaldson stressed that using all of the tools and techniques available will make surgery easier. These tools include preoperative NSAIDS, phenylephrine and ketorolac injections and Shugarcaine, as well as intraoperative tools such as iris hooks, rings and other expansion devices.
“In a floppy iris situation, I will put a hook in right underneath the wound, which can prevent any iris atrophy and damage to the iris underneath the wound,” Donaldson said.
Using a phaco chop also helps because the lens only has to be rotated minimally, assisting if there are weak zonules.
Lastly, femtosecond lasers should be used sparingly in risky cases to avoid further problems, Donaldson said. – by Rebecca L. Forand
Reference:
Donaldson K. Phaco pearls for small pupils. Presented at: Hawaiian Eye; Jan. 14-20, 2017; Koloa, Hawaii.
Disclosure: Donaldson reports she is a consultant for Alcon, Allergan, Abbott, Bausch and Lomb, Biotissue, Omeros, PRN, Sun, Shire and TearLab.