Hydrodilation Technique - A Method To Dilate Small To Medium Pupils During Cataract Surgery

Small and medium-sized pupils can pose a challenge during cataract surgery, and are associated with increased risk of complications including posterior capsule rupture, retained lens material, and increased inflammation. Current management options for small pupils include intracameral mydriatics, viscodilation, and mechanical pupil expansion with rings or hooks. All of these options have their own risks and benefits. We describe an alternative technique in which the pupil is expanded by the simple infusion pressure of the phacoemulsification probe.

Moorfields Eye Hospital, Bedford, UK

16 patients who underwent phacoemulsification with small pupils were identified. Intracameral phenylephrine 2.5% was given. Their pupils were judged to be elastic if they viscodilated. The phacoemulsification probe was introduced and the pupils were dilated at the surgeon’s standard phacoemulsification parameters. The cataract surgery was subsequently completed in each case.

In 12 of these cases, the pupil remained enlarged throughout the duration of the procedure. In 4 cases, significant pupil constriction was seen in the later stages of the surgery, particularly during lens insertion. However, 2 of the 4 patients who experienced pupil constriction were taking alpha antagonists as part of their regular medication.

Many surgeons may inadvertently use the hydrodilation technique. However, in some cases it may be associated with subsequent pupil constriction making surgery more difficult. The authors advise earlier use of mechanical expansion such as rings and hooks if possible to avoid pupil constriction later.