Small pupils can significantly complicate cataract surgery by limiting visualization and access to the lens. When pharmacologic dilation is inadequate, iris sphincterotomies provide a controlled mechanical means to enlarge the pupil. Under operating microscope visualization, a fine micro-scissors are used to make small radial incisions in the iris sphincter at the pupillary margin. These incisions relieve sphincter tension, allowing the pupil to dilate sufficiently for safe phacoemulsification and IOL implantation. Care must be taken to place incisions symmetrically to avoid pupil distortion or postoperative dysphotopsias. Iris tissue should be handled gently to prevent bleeding or iris prolapse, and viscoelastic is used to maintain anterior chamber depth. After lens removal and IOL placement, the pupil typically assumes a slightly irregular but functional shape. Is this still a good technique that has a place in your surgical toolbox? Please comment below.
