Challenges In Cataract Surgery Due To Small, Fibrotic Pupil

Poor dilatation of the pupil during the phacoemulsification can disturb the normal course of the procedure because of the low visibility in the posterior chamber. The paper intends to reveal the solutions used in a case with small pupil in order to reduce the risk of unwanted events in this case.

Faculty of Medicine, University “Lucian Blaga” din Sibiu, Romania

ARCADA Clinic Sibiu

We report the intraoperative management of a cataract surgery of a 78-year-old man diagnosed with: RE - Mature Cataract, Pupillary Fibrosis, Myopia, LE – Cortico-nuclear Cataract, Myopia.

We present the case of L.N., a 78 years old patient who presented in our clinic for decreasing vision in both eyes: BCVA RE – 0.06, BVCA LE – 0.8; IOP RE – 10 mmHg, IOP LE – 9 mmHg.

The patient had several episodes of anterior uveitis in his medical history. These led to the formation of a pupillary fibrotic membrane. The motility of the pupil was absent due to the rigid membrane. The diameter of the pupil was not large enough to permit a satisfactory visualisation of the posterior chamber. We decided to use iris hooks. The operation was performed uneventful.

The first postoperative day: BCVA RE – 1, BCVA LE – 0.8.

The mechanical dilatation of the pupil can be the solution in cases with rigid, fibrotic pupils.

The deep anterior chamber and the fragility of the iris raised further challenges in the presented case.

The postoperative results were very good with BCVA in RE of 20/20.