A Clinical Study on Complications and Visual Outcomes of Sphincterotomy In Poorly Dilating Pupils in SICS
Authors/Creators
- 1. Associate Professor, Department of Ophthalmology, Sri Venkateshwaraa Medical College, Ariyur, Puducherry, India
- 2. Senior Resident, Department of Ophthalmology, Sri Venkateshwaraa Medical College, Ariyur, Puducherry, India
Description
Background: Cataract is the leading cause of blindness in India accounting for 62% of avoidable blindness in the country. India has a high prevalence of cataract due to various factors, including a large aging population, limited access to healthcare and inadequate eye care infrastructure. The aim of the study is to evaluate intraoperative and postoperative complication and visual outcome of sphincterotomy in poorly dilating pupils in small incision cataract surgery. Method: A Study was done between January 2023 to June 2023 which included patients with poorly dilating pupils (< 6 mm) after pharmacological dilation underwent sphincterotomy in small incision cataract surgery by the same surgeon. Intraoperative postoperative complications were studied. Patients were reviewed up to 6 weeks postoperatively and visual outcome was studied. Result: Total 56 eyes with poorly dilating pupils underwent small incision cataract surgery. Sphincterotomy was done intraoperatively. Our study shows that 56 (10.9%) had poorly dilated pupils (<6 mm ) after pharmacologically dilated with tropicamide phenylephrine 0.5% eye drop. Our study shows 27 (48 %) patients associated with pseudoexfoliation. Intraoperative complications were zonular dialysis (1 eye), posterior capsular tear (1 eye). Postoperative complications were corneal oedema 3 (5.3%), anterior chamber reaction 2 (3.5%), retained cortex 2 (3.5%), atonic pupil 10 (17.8 %). 91% of patients had best corrected visual acuity more than 6/18. Conclusion: There are various methods described to make pupils wider during surgery like iris suture, healon 5, iris hook, mechanical stretching and ring expander. But these are cost-effective. Our study was done to evaluate efficacy and safety of sphincterotomy. This study on 56 eyes shows that sphincterotomy is a safe, easy-to-perform and cost effective method to obtain adequate pupil size during small incision cataract surgery.
Abstract (English)
Background: Cataract is the leading cause of blindness in India accounting for 62% of avoidable blindness in the country. India has a high prevalence of cataract due to various factors, including a large aging population, limited access to healthcare and inadequate eye care infrastructure. The aim of the study is to evaluate intraoperative and postoperative complication and visual outcome of sphincterotomy in poorly dilating pupils in small incision cataract surgery. Method: A Study was done between January 2023 to June 2023 which included patients with poorly dilating pupils (< 6 mm) after pharmacological dilation underwent sphincterotomy in small incision cataract surgery by the same surgeon. Intraoperative postoperative complications were studied. Patients were reviewed up to 6 weeks postoperatively and visual outcome was studied. Result: Total 56 eyes with poorly dilating pupils underwent small incision cataract surgery. Sphincterotomy was done intraoperatively. Our study shows that 56 (10.9%) had poorly dilated pupils (<6 mm ) after pharmacologically dilated with tropicamide phenylephrine 0.5% eye drop. Our study shows 27 (48 %) patients associated with pseudoexfoliation. Intraoperative complications were zonular dialysis (1 eye), posterior capsular tear (1 eye). Postoperative complications were corneal oedema 3 (5.3%), anterior chamber reaction 2 (3.5%), retained cortex 2 (3.5%), atonic pupil 10 (17.8 %). 91% of patients had best corrected visual acuity more than 6/18. Conclusion: There are various methods described to make pupils wider during surgery like iris suture, healon 5, iris hook, mechanical stretching and ring expander. But these are cost-effective. Our study was done to evaluate efficacy and safety of sphincterotomy. This study on 56 eyes shows that sphincterotomy is a safe, easy-to-perform and cost effective method to obtain adequate pupil size during small incision cataract surgery.
Files
IJPCR,Vol15,Issue8,Article175.pdf
Files
(1.9 MB)
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Additional details
Dates
- Accepted
-
2023-08-24
Software
- Repository URL
- https://impactfactor.org/PDF/IJPCR/15/IJPCR,Vol15,Issue8,Article175.pdf
- Development Status
- Active
References
- 1. Cause of blindness and visual impairment. (n.d) Retrieved March 16,2017 from;/www.who int/blindness/causes/en. 2. Ruit SPG, Gurung R, Tabin G, Moran D Brian G. An innovation in developing world cataract surgery. Clinexpophthalmol. 20000;28: 274- 279. 3. Henderson B, Pineda R, Chen S. Essentials of cataract surgery.1sted.SLACK incorporated; 2014. 4. Chang DF, Braga Mele R, Mammal iN, Committee at ACC. Clinical experience with. Intraoperative Floppy iris syndrome. Results of the 2008 ASCRS member survey. J cataract refractive surge.2008; 34;1201-1209 5. Chang DF, Cambell JR; Intraoperative floppy iris syndrome associated with tamsulosin. J cataract refract surg. 2005;31;664-73. 6. Wilczyński M, Wierzchowski T, Snyder A, Omulecki W. Result of phacoemulsification with Malyugin ring in comparison with manual iris stretching with hooks in eyes with narrow pupil.Eur j ophthalmol.2012. 7. Malyugin B. Cataract surgery in small pupils. Indian j ophthalmol 2017;65:1323-1328. 8. Xue Yang, Zhao Chuan Liu, A narrative review of intraoperative floppy iris syndrome an update 2020.AnnTransl Med. 2020 nov 8 (22);1546. 9. Jhanj. V, Sharma N, Vajpayee RB. middle east Afr j ophthalmol 2011, 18; 55-57. 10. Malyugin B. Review of surgical management of small pupils in cataract surgery. Use of Malyugin ring. Techno Ophthalmol 2010; 8;104 118. 11. Miller KM, Keener GT, jr stretch phalloplasty for small pupils in phacoemulsification. Am j ophthalmol.1994;117;107-8. 12. Dinsmore SC, Modified stretch technique for small pupil phacoemulsification with topical anesthesia. J cataract refract surg. 1996;22;27- 30. 13. Managing small pupils; A stepwise approach (internet). Ophthalmology Times (cited 26 March 2017). 14. Greenberg PB, Tseng VL, WuWc Jiang L, Chen CK, Scott IU, Friedmann PD. Prevalence and predictors of ocular complications associated with cataract surgery in United states veterans ophthalmology. 2011 march 1;118(3);507-14. 15. Shugar. Use of epinephrine for IFIS prophylaxis. J cataract refract surg. 2006;32;1074-1075 16. Aravind H, Raju P, Paul PG, Baskaran M, Ramesh SV, George RJ, et al. Pseudoexfoliation in South India. Br J ophthalmol. 2003 Nov;87;(11)1321-1323. 17. Anupama R Taklikar, Sajjanshetty Shashank V, Intraoperative postoperative complications in SICS patients with poorly dilating pupils. Ophthalmology and allied sciences. January - April 2018; 4;1: 1-11. 18. Padmavathi N . Usha Latha B, A clinical study of management and visual outcome in small pupils with cataract a Tertiary care center. IOSR of Dental and medical science. 15 January 2018; 17(1):51-59. 19. Sheen Ophir, Shira MD. Outcomes of first 50 cases using a new pupil expander. Journal of cataract and refractive surgery. 47(9): 1122- 1126. 20. Moreno J, Duchess, Lajara J. Pseudoexfoliation syndrome; Clinical factors related to capsular rupture in cataract surgery. Acta Ophthalmol (copenh) 1993;71;181-184. 21. Islam MN, Goswami S, Khanam BSM, Mukherji S, Complication of cataract surgery in patients with pseudoexfoliation syndrome in tertiary care Hospital of West Bengal. Int j sci study 2017;5(3); 11-15. 22. Manisha Rathi et al. Role of sphincterotomy on small pupils in SICS. Sch j app med sci, 2021 jan; 9(1) 70-73. 23. Colvard D. Achieving excellence in cataract surgery. 1st ed 2009.