Comparison of Visual Outcome in Phacoemulsification Surgery with and Without Intra-Operative Use of Pupil Dilating Device

Parth Satani; Shabnam Tanwar; Suhas Haldipurkar; Vijay Shetty; Devendra Venkatramani; Maninder Singh Setia

doi:doi:10.11648/j.ijovs.20220703.12

| Peer-Reviewed

Comparison of Visual Outcome in Phacoemulsification Surgery with and Without Intra-Operative Use of Pupil Dilating Device

Parth Satani, Shabnam Tanwar, Suhas Haldipurkar, Vijay Shetty, Devendra Venkatramani, Maninder Singh Setia

Published in International Journal of Ophthalmology & Visual Science (Volume 7, Issue 3)

Received: 24 July 2022 Accepted: 15 August 2022 Published: 24 August 2022

Views: Downloads:

Download PDF

Share This Article

Twitter
Linked In
Facebook

Abstract

Background: It may be challenging to perform phacoemulsification in cataract patients who have small or poorly dilated pupils. Objective: We conducted this cross-sectional analysis of secondary data to compare the visual outcomes, contrast sensitivity, and higher order aberrations in eyes in with and without the use of pupil dilating technique during phacoemulsification. Methods: We compared the best corrected distance visual acuity (BCDVA), pupil size and contrast sensitivity (photopic and scotopic conditions), higher order aberrations, and satisfaction in 20 eyes (18 patients) in whom no pupil dilating device was used (Group A) with 19 eyes (17 patients) in the ‘Pupil dilating device group’ (Group B). In small pupil patients, the surgeon used one of the pupil dilating technique (stretch pupilloplasty, iris-hook, or malyugin rings) for intra-operative pupil dilatation. Results: In the post-operative examination, the median (IQR) logMAR values for BCDVA was significantly lower in Group A compared with Group B (0.00 [0.00, 0.09] vs. 0.18 [0.00, 0.18], p = 0.03). However, there were no significant differences in the near vision. The mean change in pupil size was significantly more in Group A compared with Group B (0.85 [0.46] vs 0.53 [0.31]; p = 0.01). After adjusting for age, gender, and time since surgery, mean contrast sensitivity (photopic) was significantly lower in whom Iris Hooks were used compared with those in whom pupil dilating device was used (-0.270, 95% confidence intervals [CI]: -0.464, -0.076, p < 0.001). The satisfaction with vision was very high (97%). Conclusion: Pupil dilating devices are often used in small pupils. However, visual acuity and pupillary reaction may be reduced post-operatively in these patients. Thus, they should be adequately counselled about these potential side effects during the pre-surgical period.

Published in	International Journal of Ophthalmology & Visual Science (Volume 7, Issue 3)
DOI	10.11648/j.ijovs.20220703.12
Page(s)	95-100
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Pupil Dilating Devices, Visual Outcomes, Higher Order Aberrations, Contrast Sensitivity, Phacoemulsification

References

[1]	Koch DD, Samuelson SW, Haft EA, Merin LM. Pupillary size and responsiveness. Implications for selection of a bifocal intraocular lens. Ophthalmology. Jul 1991; 98 (7): 1030-5.
[2]	Vasavada A, Singh R. Phacoemulsification in eyes with a small pupil. J Cataract Refract Surg. Aug 2000; 26 (8): 1210-8. doi: 10.1016/s0886-3350(00)00361-8.
[3]	Chang DF, Campbell JR. Intraoperative floppy iris syndrome associated with tamsulosin. J Cataract Refract Surg. Apr 2005; 31 (4): 664-73. doi: 10.1016/j.jcrs.2005.02.027.
[4]	Papaconstantinou D, Kalantzis G, Brouzas D, et al. Safety and efficacy of phacoemulsification and intraocular lens implantation through a small pupil using minimal iris manipulation. Clin Interv Aging. 2016; 11: 651-7. doi: 10.2147/CIA.S97254.
[5]	Donnenfeld ED, Whitaker JS, Jackson MA, Wittpenn J. Intracameral ketorolac and phenylephrine effect on intraoperative pupil diameter and postoperative pain in cataract surgery. J Cataract Refract Surg. May 2017; 43 (5): 597-605. doi: 10.1016/j.jcrs.2017.02.030.
[6]	Megbelayin E, Pindikura S. Managing challenges of recalcitrant intraoperative miosis during small incision cataract surgery. Int J Sci Res Knowl. 2013; 1: 74-81.
[7]	Bhallil S, Andalloussi IB, El Abdouni O, Mahjoubi I, Tahri H. Is there a perioperative circulatory side effect of intracameral epinephrine in hypertensive patients undergoing phacoemulsification? Oman J Ophthalmol. Sep 2010; 3 (3): 161-2. doi: 10.4103/0974-620X.71914.
[8]	Grob SR, Gonzalez-Gonzalez LA, Daly MK. Management of mydriasis and pain in cataract and intraocular lens surgery: review of current medications and future directions. Clin Ophthalmol. 2014; 8: 1281-9. doi: 10.2147/OPTH.S47569.
[9]	Jhanji V, Sharma N, Vajpayee RB. Management of Intraoperative Miosis during Pediatric Cataract Surgery using Healon 5. Middle East Afr J Ophthalmol. Jan 2011; 18 (1): 55-7. doi: 10.4103/0974-9233.75888.
[10]	Malyugin B. Review of surgical management of small pupils in cataract surgery: Use of the Malyugin ring. Techn Ophthalmol. 2010; 8: 104-18.
[11]	Malyugin B. Cataract surgery in small pupils. Indian J Ophthalmol. Dec 2017; 65 (12): 1323-1328. doi: 10.4103/ijo.IJO_800_17.
[12]	Akman A, Yilmaz G, Oto S, Akova YA. Comparison of various pupil dilatation methods for phacoemulsification in eyes with a small pupil secondary to pseudoexfoliation. Ophthalmology. Sep 2004; 111 (9): 1693-8. doi: 10.1016/j.ophtha.2004.02.008.
[13]	Jirasková N, Rozsíval P, Lešták J. Use of Malyugin Pupil Expansion Ring in Femtosecond Laser-assisted Cataract Surgery. J Clin Exp Ophthalmol. 2013; 4 (6): 1-6.
[14]	Chang DF. Use of Malyugin pupil expansion device for intraoperative floppy-iris syndrome: results in 30 consecutive cases. J Cataract Refract Surg. May 2008; 34 (5): 835-41. doi: 10.1016/j.jcrs.2008.01.026.
[15]	Graether JM. Graether pupil expander for managing the small pupil during surgery. J Cataract Refract Surg. Jun 1996; 22 (5): 530-5. doi: 10.1016/s0886-3350(96)80004-6.
[16]	Miller KM, Keener GT, Jr. Stretch pupilloplasty for small pupil phacoemulsification. Am J Ophthalmol. Jan 15 1994; 117 (1): 107-8. doi: 10.1016/s0002-9394(14)73023-5.
[17]	Nichamin LD. Enlarging the pupil for cataract extraction using flexible nylon iris retractors. J Cataract Refract Surg. Nov 1993; 19 (6): 793-6. doi: 10.1016/s0886-3350(13)80354-9.
[18]	Novak J. Flexible iris hooks for phacoemulsification. J Cataract Refract Surg. Jul-Aug 1997; 23 (6): 828-31. doi: 10.1016/s0886-3350(97)80238-6.
[19]	Yuguchi T, Oshika T, Sawaguchi S, Kaiya T. Pupillary functions after cataract surgery using flexible iris retractor in patients with small pupil. Jpn J Ophthalmol. Jan-Feb 1999; 43 (1): 20-4. doi: 10.1016/s0021-5155(98)00055-0.
[20]	Mantyjarvi M, Laitinen T. Normal values for the Pelli-Robson contrast sensitivity test. J Cataract Refract Surg. Feb 2001; 27 (2): 261-6. doi: 10.1016/s0886-3350(00)00562-9.
[21]	Shingleton BJ, Campbell CA, O'Donoghue MW. Effects of pupil stretch technique during phacoemulsification on postoperative vision, intraocular pressure, and inflammation. J Cataract Refract Surg. Jul 2006; 32 (7): 1142-5. doi: 10.1016/j.jcrs.2006.03.010.
[22]	Koch DD, Jardeleza TL, Emery JM, Franklin D. Glare following posterior chamber intraocular lens implantation. J Cataract Refract Surg. Sep 1986; 12 (5): 480-4. doi: 10.1016/s0886-3350(86)80119-5.
[23]	Fotiou DF, Brozou CG, Tsiptsios DJ, et al. Effect of age on pupillary light reflex: evaluation of pupil mobility for clinical practice and research. Electromyogr Clin Neurophysiol. Jan-Feb 2007; 47 (1): 11-22.
[24]	Oshika T, Okamoto C, Samejima T, Tokunaga T, Miyata K. Contrast sensitivity function and ocular higher-order wavefront aberrations in normal human eyes. Ophthalmology. Oct 2006; 113 (10): 1807-12. doi: 10.1016/j.ophtha.2006.03.061.
[25]	Oshika T, Tokunaga T, Samejima T, Miyata K, Kawana K, Kaji Y. Influence of pupil diameter on the relation between ocular higher-order aberration and contrast sensitivity after laser in situ keratomileusis. Invest Ophthalmol Vis Sci. Apr 2006; 47 (4): 1334-8. doi: 10.1167/iovs.05-1154.

Cite This Article

Plain Text BibTeX RIS

APA Style

Parth Satani, Shabnam Tanwar, Suhas Haldipurkar, Vijay Shetty, Devendra Venkatramani, et al. (2022). Comparison of Visual Outcome in Phacoemulsification Surgery with and Without Intra-Operative Use of Pupil Dilating Device. International Journal of Ophthalmology & Visual Science, 7(3), 95-100. https://doi.org/10.11648/j.ijovs.20220703.12

Copy | Download

ACS Style

Parth Satani; Shabnam Tanwar; Suhas Haldipurkar; Vijay Shetty; Devendra Venkatramani, et al. Comparison of Visual Outcome in Phacoemulsification Surgery with and Without Intra-Operative Use of Pupil Dilating Device. Int. J. Ophthalmol. Vis. Sci. 2022, 7(3), 95-100. doi: 10.11648/j.ijovs.20220703.12

Copy | Download

AMA Style

Parth Satani, Shabnam Tanwar, Suhas Haldipurkar, Vijay Shetty, Devendra Venkatramani, et al. Comparison of Visual Outcome in Phacoemulsification Surgery with and Without Intra-Operative Use of Pupil Dilating Device. Int J Ophthalmol Vis Sci. 2022;7(3):95-100. doi: 10.11648/j.ijovs.20220703.12

Copy | Download

@article{10.11648/j.ijovs.20220703.12,
  author = {Parth Satani and Shabnam Tanwar and Suhas Haldipurkar and Vijay Shetty and Devendra Venkatramani and Maninder Singh Setia},
  title = {Comparison of Visual Outcome in Phacoemulsification Surgery with and Without Intra-Operative Use of Pupil Dilating Device},
  journal = {International Journal of Ophthalmology & Visual Science},
  volume = {7},
  number = {3},
  pages = {95-100},
  doi = {10.11648/j.ijovs.20220703.12},
  url = {https://doi.org/10.11648/j.ijovs.20220703.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijovs.20220703.12},
  abstract = {Background: It may be challenging to perform phacoemulsification in cataract patients who have small or poorly dilated pupils. Objective: We conducted this cross-sectional analysis of secondary data to compare the visual outcomes, contrast sensitivity, and higher order aberrations in eyes in with and without the use of pupil dilating technique during phacoemulsification. Methods: We compared the best corrected distance visual acuity (BCDVA), pupil size and contrast sensitivity (photopic and scotopic conditions), higher order aberrations, and satisfaction in 20 eyes (18 patients) in whom no pupil dilating device was used (Group A) with 19 eyes (17 patients) in the ‘Pupil dilating device group’ (Group B). In small pupil patients, the surgeon used one of the pupil dilating technique (stretch pupilloplasty, iris-hook, or malyugin rings) for intra-operative pupil dilatation. Results: In the post-operative examination, the median (IQR) logMAR values for BCDVA was significantly lower in Group A compared with Group B (0.00 [0.00, 0.09] vs. 0.18 [0.00, 0.18], p = 0.03). However, there were no significant differences in the near vision. The mean change in pupil size was significantly more in Group A compared with Group B (0.85 [0.46] vs 0.53 [0.31]; p = 0.01). After adjusting for age, gender, and time since surgery, mean contrast sensitivity (photopic) was significantly lower in whom Iris Hooks were used compared with those in whom pupil dilating device was used (-0.270, 95% confidence intervals [CI]: -0.464, -0.076, p < 0.001). The satisfaction with vision was very high (97%). Conclusion: Pupil dilating devices are often used in small pupils. However, visual acuity and pupillary reaction may be reduced post-operatively in these patients. Thus, they should be adequately counselled about these potential side effects during the pre-surgical period.},
 year = {2022}
}

Copy | Download

TY  - JOUR
T1  - Comparison of Visual Outcome in Phacoemulsification Surgery with and Without Intra-Operative Use of Pupil Dilating Device
AU  - Parth Satani
AU  - Shabnam Tanwar
AU  - Suhas Haldipurkar
AU  - Vijay Shetty
AU  - Devendra Venkatramani
AU  - Maninder Singh Setia
Y1  - 2022/08/24
PY  - 2022
N1  - https://doi.org/10.11648/j.ijovs.20220703.12
DO  - 10.11648/j.ijovs.20220703.12
T2  - International Journal of Ophthalmology & Visual Science
JF  - International Journal of Ophthalmology & Visual Science
JO  - International Journal of Ophthalmology & Visual Science
SP  - 95
EP  - 100
PB  - Science Publishing Group
SN  - 2637-3858
UR  - https://doi.org/10.11648/j.ijovs.20220703.12
AB  - Background: It may be challenging to perform phacoemulsification in cataract patients who have small or poorly dilated pupils. Objective: We conducted this cross-sectional analysis of secondary data to compare the visual outcomes, contrast sensitivity, and higher order aberrations in eyes in with and without the use of pupil dilating technique during phacoemulsification. Methods: We compared the best corrected distance visual acuity (BCDVA), pupil size and contrast sensitivity (photopic and scotopic conditions), higher order aberrations, and satisfaction in 20 eyes (18 patients) in whom no pupil dilating device was used (Group A) with 19 eyes (17 patients) in the ‘Pupil dilating device group’ (Group B). In small pupil patients, the surgeon used one of the pupil dilating technique (stretch pupilloplasty, iris-hook, or malyugin rings) for intra-operative pupil dilatation. Results: In the post-operative examination, the median (IQR) logMAR values for BCDVA was significantly lower in Group A compared with Group B (0.00 [0.00, 0.09] vs. 0.18 [0.00, 0.18], p = 0.03). However, there were no significant differences in the near vision. The mean change in pupil size was significantly more in Group A compared with Group B (0.85 [0.46] vs 0.53 [0.31]; p = 0.01). After adjusting for age, gender, and time since surgery, mean contrast sensitivity (photopic) was significantly lower in whom Iris Hooks were used compared with those in whom pupil dilating device was used (-0.270, 95% confidence intervals [CI]: -0.464, -0.076, p < 0.001). The satisfaction with vision was very high (97%). Conclusion: Pupil dilating devices are often used in small pupils. However, visual acuity and pupillary reaction may be reduced post-operatively in these patients. Thus, they should be adequately counselled about these potential side effects during the pre-surgical period.
VL  - 7
IS  - 3
ER  -

Copy | Download

Author Information

Parth Satani

Department of Ophthalmology, Laxmi Eye Institute, Panvel, India
Shabnam Tanwar

Department of Ophthalmology, Laxmi Eye Institute, Panvel, India
Suhas Haldipurkar

Department of Ophthalmology, Laxmi Eye Institute, Panvel, India
Vijay Shetty

Department of Ophthalmology, Laxmi Eye Institute, Panvel, India
Devendra Venkatramani

Department of Ophthalmology, Laxmi Eye Institute, Panvel, India
Maninder Singh Setia

Department of Ophthalmology, Laxmi Eye Institute, Panvel, India

Download PDF

Sections

Plain Text BibTeX RIS

APA Style

Parth Satani, Shabnam Tanwar, Suhas Haldipurkar, Vijay Shetty, Devendra Venkatramani, et al. (2022). Comparison of Visual Outcome in Phacoemulsification Surgery with and Without Intra-Operative Use of Pupil Dilating Device. International Journal of Ophthalmology & Visual Science, 7(3), 95-100. https://doi.org/10.11648/j.ijovs.20220703.12

Copy | Download

ACS Style

Parth Satani; Shabnam Tanwar; Suhas Haldipurkar; Vijay Shetty; Devendra Venkatramani, et al. Comparison of Visual Outcome in Phacoemulsification Surgery with and Without Intra-Operative Use of Pupil Dilating Device. Int. J. Ophthalmol. Vis. Sci. 2022, 7(3), 95-100. doi: 10.11648/j.ijovs.20220703.12

Copy | Download

AMA Style

Parth Satani, Shabnam Tanwar, Suhas Haldipurkar, Vijay Shetty, Devendra Venkatramani, et al. Comparison of Visual Outcome in Phacoemulsification Surgery with and Without Intra-Operative Use of Pupil Dilating Device. Int J Ophthalmol Vis Sci. 2022;7(3):95-100. doi: 10.11648/j.ijovs.20220703.12

Copy | Download

@article{10.11648/j.ijovs.20220703.12,
  author = {Parth Satani and Shabnam Tanwar and Suhas Haldipurkar and Vijay Shetty and Devendra Venkatramani and Maninder Singh Setia},
  title = {Comparison of Visual Outcome in Phacoemulsification Surgery with and Without Intra-Operative Use of Pupil Dilating Device},
  journal = {International Journal of Ophthalmology & Visual Science},
  volume = {7},
  number = {3},
  pages = {95-100},
  doi = {10.11648/j.ijovs.20220703.12},
  url = {https://doi.org/10.11648/j.ijovs.20220703.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijovs.20220703.12},
  abstract = {Background: It may be challenging to perform phacoemulsification in cataract patients who have small or poorly dilated pupils. Objective: We conducted this cross-sectional analysis of secondary data to compare the visual outcomes, contrast sensitivity, and higher order aberrations in eyes in with and without the use of pupil dilating technique during phacoemulsification. Methods: We compared the best corrected distance visual acuity (BCDVA), pupil size and contrast sensitivity (photopic and scotopic conditions), higher order aberrations, and satisfaction in 20 eyes (18 patients) in whom no pupil dilating device was used (Group A) with 19 eyes (17 patients) in the ‘Pupil dilating device group’ (Group B). In small pupil patients, the surgeon used one of the pupil dilating technique (stretch pupilloplasty, iris-hook, or malyugin rings) for intra-operative pupil dilatation. Results: In the post-operative examination, the median (IQR) logMAR values for BCDVA was significantly lower in Group A compared with Group B (0.00 [0.00, 0.09] vs. 0.18 [0.00, 0.18], p = 0.03). However, there were no significant differences in the near vision. The mean change in pupil size was significantly more in Group A compared with Group B (0.85 [0.46] vs 0.53 [0.31]; p = 0.01). After adjusting for age, gender, and time since surgery, mean contrast sensitivity (photopic) was significantly lower in whom Iris Hooks were used compared with those in whom pupil dilating device was used (-0.270, 95% confidence intervals [CI]: -0.464, -0.076, p < 0.001). The satisfaction with vision was very high (97%). Conclusion: Pupil dilating devices are often used in small pupils. However, visual acuity and pupillary reaction may be reduced post-operatively in these patients. Thus, they should be adequately counselled about these potential side effects during the pre-surgical period.},
 year = {2022}
}

Copy | Download

TY  - JOUR
T1  - Comparison of Visual Outcome in Phacoemulsification Surgery with and Without Intra-Operative Use of Pupil Dilating Device
AU  - Parth Satani
AU  - Shabnam Tanwar
AU  - Suhas Haldipurkar
AU  - Vijay Shetty
AU  - Devendra Venkatramani
AU  - Maninder Singh Setia
Y1  - 2022/08/24
PY  - 2022
N1  - https://doi.org/10.11648/j.ijovs.20220703.12
DO  - 10.11648/j.ijovs.20220703.12
T2  - International Journal of Ophthalmology & Visual Science
JF  - International Journal of Ophthalmology & Visual Science
JO  - International Journal of Ophthalmology & Visual Science
SP  - 95
EP  - 100
PB  - Science Publishing Group
SN  - 2637-3858
UR  - https://doi.org/10.11648/j.ijovs.20220703.12
AB  - Background: It may be challenging to perform phacoemulsification in cataract patients who have small or poorly dilated pupils. Objective: We conducted this cross-sectional analysis of secondary data to compare the visual outcomes, contrast sensitivity, and higher order aberrations in eyes in with and without the use of pupil dilating technique during phacoemulsification. Methods: We compared the best corrected distance visual acuity (BCDVA), pupil size and contrast sensitivity (photopic and scotopic conditions), higher order aberrations, and satisfaction in 20 eyes (18 patients) in whom no pupil dilating device was used (Group A) with 19 eyes (17 patients) in the ‘Pupil dilating device group’ (Group B). In small pupil patients, the surgeon used one of the pupil dilating technique (stretch pupilloplasty, iris-hook, or malyugin rings) for intra-operative pupil dilatation. Results: In the post-operative examination, the median (IQR) logMAR values for BCDVA was significantly lower in Group A compared with Group B (0.00 [0.00, 0.09] vs. 0.18 [0.00, 0.18], p = 0.03). However, there were no significant differences in the near vision. The mean change in pupil size was significantly more in Group A compared with Group B (0.85 [0.46] vs 0.53 [0.31]; p = 0.01). After adjusting for age, gender, and time since surgery, mean contrast sensitivity (photopic) was significantly lower in whom Iris Hooks were used compared with those in whom pupil dilating device was used (-0.270, 95% confidence intervals [CI]: -0.464, -0.076, p < 0.001). The satisfaction with vision was very high (97%). Conclusion: Pupil dilating devices are often used in small pupils. However, visual acuity and pupillary reaction may be reduced post-operatively in these patients. Thus, they should be adequately counselled about these potential side effects during the pre-surgical period.
VL  - 7
IS  - 3
ER  -

Copy | Download