Small Pupils: an Indication of Phacoemulsification

OBJECTIVES: To demonstrate that cataracts with small pupils should be operated on by phacoemulsification. Thirty-five eyes with a pupil diameter of less than 3 mm at the beginning of the procedure were reviewed. They were compared with 48 eyes with small pupils, operated by extracapsular cataract extraction (ECCE) with iridoplasty during the period 1990–1992. SETTING: Eye Clinic, University of Verona, Italy. MAIN OUTCOME MEASURES: Clear corneal incisions were adopted. Viscoelastic (Healone®) was used to enlarge the pupil. Intraoperative and postoperative complications were analysed. RESULTS: In 5 eyes (14%) a rupture of the capsulorhexis developed. In one eye the tear extended to the posterior capsule. In 4 eyes (11%) the iris was caught by the phaco-tip, which was connected to a diaphragmatic pump. Damage to the iris from the sleeve of the phaco-tip was observed in 20 eyes. Postoperatively, a fibrinous reaction developed in 11 eyes, lasting 7–10 days. CONCLUSIONS: Eyes with small pupils are most frequently eyes treated by miotics for glaucoma. For these eyes, clear corneal incision and phacoemulsification seems preferable to ECCE with iridoplasty.