Abstract
Purpose:
To determine if pupil expansion with the Malyugin Ring™ during phacoemulsification cataract extraction has an effect on intraocular pressure and vision in the immediate postoperative period.
Methods:
This is a retrospective analysis of the postoperative course of 20 consecutive phacoemulsification procedures utilizing the Malyugin Ring™ at an academic teaching hospital in the Bronx, NY (Group I). A control group of 21 patients undergoing cataract surgery during the same time period were matched for age, gender and primary surgeon (Group II). Patients underwent standard phacoemulsification with posterior chamber intraocular lens implantation without complication. A detailed chart review was performed, and intraocular pressure (IOP) and best uncorrected visual acuity (VASC) were evaluated for the first postoperative month.
Results:
There were no significant differences in IOP on the first postoperative day between Group I and Group II (95% CI 13.8-17.4 mm Hg and 14.7-18.5 mm Hg, respectively). Likewise, no significant differences were noted between the Groups at the one month postoperative visit (95% CI 14.7-17.4 mm Hg and 13.6-16.2 mm Hg, respectively). In Group I there was one patient with an early IOP elevation of ≥ 30 mm Hg, as compared to two patients in Group II. Compared to preoperative measurements, Group I lost 1.3 lines of vision as measured by Snellen acuity on post-op day 1, but gained 1.5 lines by post-op month 1. Group II gained 0.4 lines on post-op day 1 and gained 2.3 lines by post-op month 1. The relative change in visual acuity was not significantly different between Group I and Group II.
Conclusions:
Pupil manipulation during cataract surgery may lead to pigment dispersion with subsequent inflammation, IOP elevation, and damage to the corneal endothelium. Our study demonstrates that the use of the Malyugin Ring™ for pupil expansion during cataract surgery is not an independent risk factor for increased postoperative IOP, or for early IOP elevation of ≥ 30 mm Hg. There was, however, a trend toward early lower VASC in patients requiring Malyugin Ring™ insertion, however by post-op month 1, visual outcomes in these patients were comparable to controls. The potential risks of the Malyugin Ring™ are likely outweighed by the benefits of improved surgical exposure and reduced likelihood of complications related to intraoperative floppy iris syndrome (IFIS).
Keywords: 445 cataract •
568 intraocular pressure