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Small pupil and cataract surgery

Hashemi, Hassana,b; Seyedian, Mohammad A.a; Mohammadpour, Mehrdadb

Current Opinion in Ophthalmology: January 2015 - Volume 26 - Issue 1 - p 3–9
doi: 10.1097/ICU.0000000000000116

Purpose of review Presence of a small pupil is still considered a major challenge for cataract surgeons. Appropriate mydriasis and maintaining it is of paramount importance to prevent potential serious complications. Recently, more interventions and instruments are available for the cataract surgeons to deal with these challenging cases. The intention of this review is to discuss the preoperative and intraoperative considerations and techniques for cataract surgery in small pupil and related conditions and to discuss new developments in management of small pupil in femtosecond laser-assisted cataract surgery.

Recent findings There are new techniques and pharmaceuticals available to cataract surgeons in the setting of small pupil. Intracameral ketorolac may soon be available to maintain mydriasis and to control pain and inflammation. Malyugin ring has been added to pupil expansion rings and has already been used for small pupil in different settings. In femtosecond laser-assisted cataract surgery, presence of a small pupil can now be managed by applying intracameral mydriatics and intraocular devices successfully.

Summary Accurate preoperative examinations adjunct with intraoperative use of appropriate pharmacologic and mechanical devices can yield favorable outcomes in cataract surgery with a small pupil.

aNoor Ophthalmology Research Center, Noor Eye Hospital

bDepartment of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran

Correspondence to Hassan Hashemi, MD, Noor Ophthalmology Research Center, Noor Eye Hospital, 106 Esfandiar Blv, Valie-Asr Ave, 19686-53111 Tehran, Iran. Tel: +98 21 82400 x1607; fax: +98 21 8865 0501; e-mail:

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