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CL Hagedorn, BM DeBroff, EM Candal, L Dragan; Pupilometry as a Predictor of Complications in Cataract Surgery . Invest. Ophthalmol. Vis. Sci. 2002;43(13):376.
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Pupose: The goal of this study is to quantitatively evaluate the relationship between pupil size and incidence of surgical complications in cataract surgery. While it is generally recognized that smaller pupils make for more difficult surgery and possibly a higher rate of complications, there is not a consensus as to what constitutes a "small pupil". There is limited data in the literature regarding pupillary measurement as it relates to specific rates of surgical complications. It is the ultimate goal of this study to help guide cataract surgeons when pupillary size may constitute a significant risk factor and perhaps require surgical technique alterations such as mechanical means of enlarging pupillary size. Methods: This study is a prospective chart review of patients undergoing elective cataract surgery at the West Haven Connecticut Veteran's Hospital from September to December, 2001. A total of 38 cases between 2 PGY-4 surgeons: LD; n=5 and EC; n=33, were included. Pupil diameter was measured immediately prior to surgery using the Colvard Pupilometer device(OASIS; Glendora, CA). Phacoemulsification cataract surgery was carried out in a divide and conquer technique. No mechanical pupillary enlarging procedures were performed in any of the study cases. Charts were then reviewed and pupil size, surgical outcome, and postoperative course were recorded. Data recorded included patient sex, age, medical history, ocular history, intraocular lens used, and surgical technique. Complications included posterior capsule tear, vitreous loss, post-op intraocular pressure spikes, endophthalmitis, dropped or retained cortex, inadequate capsulorhexis requiring sulcus lens placement, and conversion to large incision extracapsular cataract surgery. Results: Results based on 38 cases show no significant difference in mean pupil size between cases with and without complications: 7.0mm in the non-complication group and 6.7mm in the complication group with a p-value of 0.495 by t-test. There were no complications with a pupil size greater than 8.25mm, and all cases under 5.0mm were associated with complications. Conclusion: Early results demonstrate a trend of more frequent complications in phacoemulsification cataract surgery with smaller pupils. Future studies are underway to include additional patients for a larger sample size and a greater range of pupil sizes. Such investigations will help guide cataract surgeons to adjust their surgical technique to avoid complications.
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