Efficiency of pupillary stretching in cataract surgery

Purpose. To assess the efficiency of pupillary stretching with iris hooks i n poorly dilatable pupils during phacoemulsification. Methods. Forty eyes with maximal preoperative mydriasis less than 4.5 mm (m ean 3.9 mm S.D. 1.0) received bimanual pupillary stretching according to th e technique of Miller and Keener (1994). Results. Small pupils were mainly caused by long-term pilocarpine therapy ( n = 21), posterior synechia (n = 11) or diabetic iridopathy (n = 7). With m ultidirectional stretching, the pupil could be enlarged to mean 6.6 mm (S.D . 0.66), lasting throughout phacoemulsification. The effect of stretching w as significantly greater in eyes with synechias, but no significant differe nces in post-operative pupil motility was observed between the three subgro ups. Six eyes with pronounced postoperative inflammation responded well to antiinflammatory treatment. Conclusions. Done with routine surgical instruments, bimanual pupillary str etching seems to be an easy, safe and effective procedure for enlarging sma ll pupils by an average of 2.7 mm during phacoemulsification, especially in eyes with posterior synechias.