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Clinically significant intraoperative miosis in FLACS: risk factors and NSAID topical pretreatment impact

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Session Details

Session Title: Cataract Surgery & Glaucoma

Session Date/Time: Sunday 23/09/2018 | 14:00-16:00

Paper Time: 15:44

Venue: Room A3, Podium 1

First Author: : N.Anisimova RUSSIA

Co Author(s): :    L. Arbisser   N. Sobolev   B. Malyugin              

Abstract Details


To report the incidence of clinically significant intraoperative miosis in uncomplicated FLACS with instillations of various NSAIDs


S. Fyodorov Eye Microsurgery State Institution, Moscow, Russia


Preoperatively, the FLACS patients were administered (QD and QID,respectively) either a topical bromfenac 0.09% (Group1;35 eyes) or indomethacin 0.1% (Group2;30 eyes). All surgeries were recorded. Pupil size was assessed during the postop analysis of captured video frames with ImageJ program at 5 different time points:before FLACS (I⌀), right after FLACS (II⌀),before CPE (III⌀),at aspiration/irrigation (IV⌀), at the end of the surgery (V⌀). The threshold ratio of clinically significant intraoperative miosis (CSIM) was set at 5.0mm (the size of anterior capsulotomy). Intraoperative IOP was registered with Tonopen (Reichert, USA) before(1) and immediately after femtosecond laser(FSL-) pretreatment(2) and in 15min(3).


In the Group 1 the CSIM was registered at V⌀ 1(2.9%). In the Group 2 the CSIM was observed in II⌀, III⌀, IV⌀, V⌀ 1(3.3%), 3(10%), 2(6.7%), 5(16.7%), respectively. Negative correlations were defined between pupil size and age (r=–0.35, p<.006 (III⌀); r=–0.30, p<.02 (IV⌀)); pupil size II⌀ negatively correlated with IOP (3) (r=–0.42,p<.05), III⌀ with IOP (2) and IOP (3) (r=–0.38, p<.05;r=–0.35,p<.05, respectively), V⌀ with IOP (2) and IOP (3) (r=–0.45,p<.001;r=–0.43,p<.001, respectively), low negative correlation defined between II⌀ with anterior capsulotomy incision depth (r=–0.27,р<.05).


There were no statistically significant differences between intraoperative pupil sizes in both groups, however clinically significant pupil size reduction was observed in the group with indomethacin preoperative instillations. Pupil size during surgery was more stable in the bromfenac group. Risk factors for intraoperative miosis included age, IOP fluctuations, anterior capsulotomy incision depth.

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