Iris retractors useful in small pupil surgery

Iris retractors are a safe and useful addition to small pupil phacoemulsification, according to Arup Chakrabarti and colleagues from the Chakrabarti Eye Care Centre, India.

The researchers enrolled 78 consecutive patients with small pupils undergoing phacoemulsification using a flexible iris retractor, into a retrospective study. All subjects underwent surgery with peribulbar anaesthesia using the Alcon Universal II phaco unit or the Bausch & Lomb Millenium unit. Four iris hooks were used to retract the pupil to the desirable size, under adequate viscoelastic cover, for safe phacoemulsification using the direct chop or stop and chop techniques.

The maximum preoperative mydriasis achieved was just 3 mm. Intraoperative events and complications included: mild Descemet's stripping (2.56%), anterior capsular rupture (1.28%), punctate haemorrhagic spots on the papillary margins (39.7%), retroirideal bleed (1.28%) and transient iris incarceration in the wound while retracting the hooks (17.9%). Linera imprint marks were seen in 44.8% of the subjects. In terms of visual acuity, 73% achieved a best corrected visual acuity (BCVA) of 6/12 or better and BCVAs of less than 6/60 were attributed to primary retinal pathology.

It was concluded that iris retractors are useful and safe to use for small pupil phacoemulsification, however, care must be taken to use the correct technique in order to avoid unnecessary complications.