How do we do cataract surgery in an eye with a mid-sized pupil of about 3 or 4 mm in diameter? Do we need to use iris hooks or iris expansion devices? Do we need to stretch the pupil mechanically? Do we need to perform sphincterotomies of the iris at the pupil margin? The answer to all of the above is NO! Those extra steps are not needed. We simply need to instill anesthetic and mydriatric agents at the time of cataract surgery, then use our visco-elastic to perform visco-mydriasis. We can then make a capsulorhexis which is bigger than the pupil size by carefully going under the iris, and finally the lens nucleus can be prolapsed out of the capsular bag and held in position by the iris.
The Mind-Trick: You can make the capsulorhexis larger than the pupil without directly visualizing the edge. It’s in your mind — you know where the rhexis should be, just have faith and go for it and you will be able to create a perfect capsulorhexis without seeing the edge.
Figure: This patient has a 4 mm pupil at the start of cataract surgery. We will show you a technique to do this case safely and effectively without the use of iris hooks or iris pupil expansion devices.
watch the video with voice-over here:
Uday Devgan, MD is in private practice at Devgan Eye Surgery in Los Angeles, partner at Specialty Surgical Center in Beverly Hills, Chief of Ophthalmology at Olive View-UCLA Medical Center, and award-winning Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, UCLA School of Medicine.