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Small pupil phacoemulcifiction

Small pupil phacoemulcifiction. A preoperative evaluation should include pupillary dynamics Poor pupillary dilatation should be detected and noted Appropriate history is important for detecting any underlying etiology of the miotic pupil ( use of miotics or long-standing diabetes )

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Small pupil phacoemulcifiction

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  1. Small pupilphacoemulcifiction A preoperative evaluation should include pupillary dynamics Poor pupillary dilatation should be detected and noted Appropriate history is important for detecting anyunderlying etiology of the miotic pupil(use of miotics or long-standing diabetes) intraop miosis(iris manipulation)

  2. Small pupilphacoemulcifiction Any co-existing condition, such as zonular weaknessin pseudoexfoliationor synechiae in chronic uveitis, should be detected preoperatively

  3. Sphincter-sparing techniques Pharmacological mydriasis: combination ofcycloplegic, mydriatic and NSAID drops. not effective in cases withposterior synechiae, pupillary membrane or scarred pupils. Such pupils need intraoperative procedures. High molecular weight cohesive viscoelasticssuch as Healon 5 or Healon GV can be injected into the center of the pupil

  4. Sphincter-sparing techniques If this does not work, synechiolysis may be donewith a blunt spatula passed through the side-port incision. Viscomydriasis can then be repeated. Pupillary membranes can be strippedmechanically by Utrata forceps Pure, preservative-free adrenaline can be added to the irrigation bottle after appropriate dilatation (Care should be taken inhypertensives)

  5. Sphincter-involving techniques • Dilatation can also be achieved by pupillary stretchingusing push-pull instruments. Under viscoelastic cover, two hooks are used in a slow, simultaneous, controlled fashion to stretch the pupil in or more axes.

  6. Stretch pupilloplasty with Kuglen's hooks

  7. Sphincter-involving techniques Mini sphincterotomies less than 1 mm and limited to the sphincter tissue, can be made with eitherVannas scissors orvitreoretinal scissors. This gives adequate dilatation intraoperatively and maintains a functionally and aesthetically normal pupil postoperatively.

  8. Mini sphincterotomies

  9. Pupil stretcher devices

  10. Sphincter-involving techniques iris hooks • Commercially available iris hooks can be used to stretch small pupilsThe disadvantage of pupil stretch techniques is that the iris sometimes becomes flaccid andprolapsesthrough the incision during surgery

  11. iris hooks

  12. Sphincter-involving techniques Pupil rings • Pupil ringshave been introduced to stretch the pupil without sphincter damage • They are inserted through the main port and manipulated into the pupil space The Perfect Pupil developed by John Milverton, MD

  13. Sphincter-involving techniques • It can be inserted through an incision of less than 100 µm. Because of the open ring design of the Perfect Pupil, there is no interference with other instrumentation.

  14. Sphincter-involving techniquesMalyugin ring • It is inserted with forceps or injected with an injector through the main port

  15. ضمن عرض پوزش بدلیل حجم بالای LECTUER ادامه اسلایدها امکان پذیر نمیباشد در صورت نیاز به ادامه لطفا به واحد سمعی و بصری مرکز آموزشی درمانی فیض مراجعه و یا با شماره تلفن 03114476010 داخلی 392تماس حاصل نمائید با تشکر

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