THE INCIDENCE OF ATONIC PUPIL FOLLOWING CATARACT-SURGERY

Objective: To determine and compare the incidence of atonic pupil foll owing modern extracapsular cataract extraction and small-incision phac oemulsification with lens implantation in a large series of consecutiv e patients. Patients and Design: A retrospective review was undertaken of 1283 consecutive cases of cataract surgery with posterior chamber intraocular lens implantation (919 extracapsular and 364 small-incisio n phacoemulsification) performed by two surgeons between October 30, 1 991, and June 30, 1993. Postoperative atonic pupil was defined as a pu pil that, following cataract surgery, was 6 mm or more in diameter and minimally or nonreactive to light, accommodation, or 1% pilocarpine h ydrochloride. Results: Postoperatively, 25 (1.95%) of 1283 eyes develo ped an atonic pupil following cataract extraction with posterior chamb er intraocular lens implantation (21 [2.29%] of 919 extracapsular and four [1.10%] of 364 phacoemulsification procedures). When an atonic pu pil was present following surgery, disturbing glare often resulted, de spite a well-centered intraocular lens. Conclusions: To our knowledge, this is the first large, consecutive study of the incidence of atonic pupil following modern cataract surgery and the first study to compar e the incidence of atonic pupil following extracapsular surgery vs sma ll-incision phacoemulsification. Although the incidence of atonic pupi l may be lower following phacoemulsification, caution is advised in th e implantation of ever-smaller optic lenses.