While we think that an 8 mm pupil is very well dilated, we must remember that the capsular bag has a diameter of 9 to 10 mm. In a few cases, we can directly visualize the capsular bag equator during cataract surgery, however in most surgeries this is not the case. When we have a smaller pupil that is 5 mm in diameter or less, even more of the space within the capsular bag is hidden.
We can use the chopper or other second instrument to lift the iris and check all quadrants of the capsular bag. We are looking for two things: (1) to make sure that both haptics and the optic are within the capsular bag, and (2) to ensure that there is no residual lens material such as adherent cortex or a small nuclear chip.
The technique shown in this video is relatively easy to perform, particularly if you do it just after IOL insertion when the anterior segment is still full of cohesive viscoelastic. This will keep the eye inflated even if we slightly distort the main incision. If you do this on every one of your smaller pupil cases, you will be surprised at the number of times that you find an issue that needs to be addressed.
Click below to learn this great surgical pearl:
