CATARACT-SURGERY FOR NARROW PUPILS AND PO STOPERATIVE REACTION TO FIBRIN, ESPECIALLY AFTER SPHINCTERECTOMY

Background: Since increased intraoperative iris irritation can lead to increased postoperative inflammation,we are interested in postoperati ve reactions to several varied surgical procedures. We performed pupil stretching, iridotomy with iris suture, and partial sphincterectomy. Materials and methods: From January 1995 to January 1996, 100 patients (103 eyes) with narrow pupils underwent cataract surgery. In 13 eyes a iridotomy and iris suture were performed, in 28 eyes a partial sphin cterectomy. In 62 eyes there was no surgical intervention after pupil stretching. Postoperative examinations were carried out in the early p ostoperative phase (up to 5 days postoperative) as well as 4 weeks aft er surgery. Fibrin reaction was classified according to 3 grades:(I) f aint fibrinous threads, (II) fibrinous net,and (III) membranous fibrin exsudation. Results: In the group without additional surgery there wa s a fibrinous reaction of grade I and II in 11 eyes. This complication occurred after iridotomy and iris suture in four cases and after sphi ncterectomy in four cases. While the intensity of fibrinous reaction w as comparable in the first two groups,the fibrinous reaction after sph incterectomy was more intensive in one eye (grade III). However, respo nse to intensive local antiphlogistic therapy was good. Frequency of f ibrinous reaction in the three groups was statistically not significan t. It should be pointed out that there was a partial restoration of pu pil movements through sphincterectomy: mean pupil diameter was 4 mm, a nd 2.5 mm under exposure to light. Three patients had no pupillary rea ction at all. Conclusions: Partial sphincterectomy facilities intraope rative manipulations of cataract surgery. Postoperative inflammatory r eaction is rare and was very responsive to medical treatment. The reco nstruction of pupillary movement is part of full visual function and, last but not least a round pupil is aesthetically more desirable.