Femto cataract surgery and small pupils

Femtosecond laser–assisted cataract surgery requires adequate dilation for imaging and treatment. Germany researchers report strategies for treating eyes with small pupils. 40 eyes with an intraoperative pupil size smaller than 5.5mm received sequential treatments to achieve a pupil larger than 5.5mm in three steps: (1) intracameral administration of epinephrine solution, (2) additional viscomydriasis, and (3) implantation of a Malyugin ring pupil expander. When a step enlarged the pupil to at least 5.5mm, femtosecond laser–assisted cataract surgery with an anterior capsulotomy diameter of at least 4.5mm and 350 μm nuclear fragmentation grids, ultrasound phacoemulsification and intraocular lens implantation were performed. Seven per cent of eyes required only epinephrine to achieve a pupil larger than 5.5mm. Additional viscomydriasis was necessary in 25 per cent, and the pupil expander was implanted in 68 per cent. The most frequent comorbidities were pseudoexfoliation of the lens capsule (30.0 per cent) and intraoperative floppy-iris syndrome (12.5 per cent). Tongue-like lesions of the capsulotomies were detected in five eyes. The researchers report that this approach allowed the surgeon to increase the efficiency and safety of femtosecond- assisted cataract surgery in eyes with a small preoperative pupil, providing good safety margins at the pupil boundary for the capsulotomy and the softened nuclear volume. 35 LOOKING FOR A NEW PREMIUM OFFER? ALSANZA, German manufacturer of medical and pharmaceutical liquids, extends its activities to Surgical Ophthalmology, focusing on: IOLs OVDs Knives BSS Phaco

I Conrad-Hengerer et al, JCRS, “Femtosecond laser-assisted cataract surgery in eyes with a small pupil”, Volume 39, Issue 9 – 1314-1320.