Pupillary functions after cataract surgery using flexible iris retractor in patients with small pupil

Purpose: To quantitatively assess pupillary functions after small pupil cat aract surgery using the flexible iris retractor. Methods: Subjects were 11 patients (12 eyes) with small pupils who underwen t phacoemulsification and intraocular lens implantation. Pupils were enlarg ed using the flexible iris retractor intraoperatively, and postoperative ir iscorder data were compared with the data of 20 normal controls who underwe nt standard phacoemulsification and intraocular lens implantation. Results: Although pupillary area before light stimulus did not differ betwe en the groups, contraction rate after light stimulus was significantly lowe r in the small pupil group than in the normal controls. The velocity of con traction and dilation was also significantly slower in the small pupil grou p. Wider pupillary stretching during surgery resulted in deteriorated pupil lary functions after surgery. Eyes of patients on long-term miotic therapy with pilocarpine showed poorer pupillary reaction postoperatively. Conclusion: Inappropriate use of the flexible iris retractor causes an aton ic, chronically enlarged postoperative pupil. To avoid postoperative pupill ary complications, miotic pupils should not be stretched to larger than a 5 .0 x 5.0 mm square. Jpn J Ophthalmol 1999; 43:20-24 (C) 1999) Japanese Opht halmological Society.