Phacoemulsification with iris retractor for poorly dilated pupil

Objective To evaluate the surgical outcome in cases of miosis after phacoemulsification with or without using flexible iris retractors.Methods 38 cataract patients (43 eyes) with small pupils underwent phacoemulsification and foldable intraocular lens implantation by using flexible iris retractor intraoperatively for enlarging the pupil , these data were compared with small pupils of 15 cataract patients (18 eyes) without using iris retractor (control).Results In the group of using iris retractor, 25.6% of eyes had mild intraoperative iris bleeding, but no posterior capsule rupture or injury of the iris by phacoemulsification tip during the operation. 71.4% eyes achieved visual acuity better than 0.2(4/20)on the first day, and 59.5% better than 0.5(10/20) 3 months postoperatively. Light reflex of pupils slowed in 95.3%, and disappeared in 4.7% because of excessive stretching of the pupils by using iris retractor, and 4.7% of eyes with glare. In the control group: 55.5% of eyes showed mild to moderate iris bleeding, 11.1% with posterior capsule rupture and 33.3% with injury of the iris by intraoperative phacoemulsification tip. 55.6% got better vieibilit than 0.2(4/20) on the first day, and 16.7% better than 0.5(10/20)3 months postoperatively. Light reflrx of pupils slowed in 61.1%, disappeared in 38.9%, and 27.8% of eyes with glare.Conclusion Using iris retractor in small poor dilated pupils may minimize the trauma of iris, reduce the inflammation, and increase safety of the operation. Proper management paracenteses and gradual enlargement of the pupil to perhaps no more than 5.0 mm are important.