Comparison of Different Pupil Dilatation Methods For Phacoemulsification In Eyes With A Small Pupil

Purpose: To compare 6 methods for intraoperative pupil dilatation in eyes with insufficient pupil size during phacoemulsification. Methods: : This was a prospective case-control study. 99 microcoria cataract patients (120 eyes) were collected and were divided into 6 groups（20 eyes each group）, and their pupils were dilated by bimanual stretching pupil (group I), pupil radial cut open(group II), mechanical pupil dilatation with iris-retractor hooks (group III), OASIS iris expander (group IV), and Malyguin-ring (Microsurgical company, America) (group V) , B-HEX Pupil Expander (Med Invent Devics, India )(group VI) ,respectively. 3.0 mm clear corneal incision were used in phacoemulsification. All cases were followed up at 1 week and 1, 3, 6 months after the surgery. The best corrected visual acuity(BCVA), intraocular pressure(IOP), corneal endothelium cell density(ECD), pupil diameter(PD) of before and after surgery were compared. Independent sample t test was used for the analysis. Results: : One same doctor finished all cataract surgeries successfully. The eyes’ condition before surgery and at 6 months after surgery were compared. There were no significant statistical differences for the conditions of the eyes before surgery among six groups. There were also no significant statistical differences for BCVA and IOP at 6 months postoperatively among six groups. The ECDs were better at 6 months postoperatively in group III and V: 2021±521/mm 2 , 2089±729/mm 2 . There were statistically significant differences (P=0.000). PD was largest in group II:5.58±0.74mm, but there were no statistically significant differences (P>0.05) Conclusions: : All 6 methods used in this study were effective for the mechanical dilatation of small pupils and didn’t affect the postoperative visual acuity and intraocular pressure in microcoria cataract phacoemulsification. Iris-retractor hooks and the Malyugin Ring can reduce intraoperative corneal endothelium cell loss. Postoperative PD is larger when the iris was cut open radially.