Combined Impact Of Age, Pseudoexfoliation, And Alpha-1 Blocker Use On Intraoperative Complications In Small-Pupil Cataract Surgery
Published 2026 - 44th Congress of the ESCRS
Reference: FP09.07 | Type: Free paper | DOI: 10.82333/d59w-5w31
Authors: Dr Sevgi Tongal* 1 , Dr Selahattin Emirhan Kanık 1 , A/Prof. Nilay Kandemir Beşek 1 , Prof. Dr Ahmet Kırgız 1
1Cataract and Refractive Surgery Department,Beyoğlu eye Training and Research Hospital, İstanbul,Türkiye
Purpose
To evaluate the impact of age, pseudoexfoliation (PEX), and benign prostatic hyperplasia treated with α₁-adrenergic blockers (BPH) on intraoperative complications in small-pupil cataract surgery.
Setting
Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey.
Methods
This retrospective clinical study included 129 small-pupil cases identified among 4,594 cataract surgeries performed between January and December 2024. Small pupil was defined as inadequate pharmacologic dilation despite a standard mydriatic protocol. Demographic, systemic, and ocular data including age, PEX, BPH and surgical parameters were analyzed. Intraoperative complications (posterior capsule rupture, intraoperative floppy iris syndrome (IFIS), nucleus drop, zonular dialysis) were recorded. Statistical analyses included chi-square, ROC curve, and multivariate logistic regression.
Results
Small pupil incidence was 2.8%. Intraoperative complications occurred in 13 cases (10.1%): IFIS in 9 (7.0%), posterior capsule rupture in 2 (1.6%), total zonular dialysis in 1 (0.8%), and nucleus drop in 1 (0.8%). ROC analysis identified 70 years as the optimal cutoff (AUC = 0.751). All complications were observed in patients aged ≥70 years (p = 0.001). Complication rates were significantly higher in patients with PEX (18.5% vs 4.0%, p = 0.015) and BPH (26.1% vs 6.6%, p = 0.012). A stepwise increase was observed: 1.6% in patients without PEX or BPH, 14.0% with PEX alone, 16.7% with BPH alone, and 36.4% in patients with both (OR = 6.9; p = 0.014). In multivariate analysis, BPH was identified as an independent predictor (OR = 4.9; p = 0.023).
Conclusions
In small-pupil cataract surgery, age ≥70 years, PEX, and α₁-blocker use each increase the risk of intraoperative complications. The coexistence of PEX and BPH synergistically amplifies this risk nearly sevenfold. Preoperative identification of these factors and early use of mechanical pupil expansion techniques may significantly enhance surgical safety by reducing the impact of combined zonular and iris instability.