Laser-assisted cataract surgery in small pupils using mechanical dilation devices

To describe methods for performing laser-assisted cataract surgery in small pupils.

Iris retractors or a Malyugin Ring (Microsurgical Technology, Redmond, WA) were used for mechanical pupil dilation before laser capsulotomy and lens fragmentation. The laser treatment can be performed with or without use of ophthalmic viscosurgical devices (OVD).

In 73 eyes with small pupils, laser treatment was possible after mechanical dilation device installation. With and without an OVD, no flattening of the anterior chamber or other complications occurred during re-docking, laser treatment, or the manual part of the operation. Small adhesions of the anterior capsulotomy were more frequent when the anterior chamber was still filled with the OVD and did not occur when the OVD was removed.

A small, poorly dilating pupil constitutes a major challenge in cataract surgery, particularly when performing capsulorhexis. Femtosecond laser treatment can be employed with considerable benefit for the patient, even in these difficult cases.