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DL Galiani, A Aminlari; Atonic Pupil Following Cataract Extraction: Incidence Over a Ten Year Period . Invest. Ophthalmol. Vis. Sci. 2002;43(13):386.
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Purpose: Investigate the incidence of atonic pupil following cataract surgery over a ten-year period. Methods: Retrospective chart review. Results: 7 cases following 1114 cataract surgeries. Conclusion: Atonic pupil is a relatively rare multifactorial complication following cataract surgery. Atonic pupil following cataract extraction is a relatively uncommon complication that tends to be disturbing to the patient, as well as the surgeon. We report seven cases over a ten year period that developed atonic pupil after uncomplicated extracapsular cataract extraction with phacoemulsification. Five cases were with scleral tunnel, two with clear cornea and topical anesthesia. The purpose of our retrospective study was to determine the incidence of atonic pupil in our practice and to investigate a possible common denominator and/or etiology. Although reports of atonic pupil have been published previously, our study is the first that involves clear cornea cataract extractions. Patients with atonic pupil typically present after surgery with a normal exam, only to return in the second to third week with a dilated non-reactive or minimally reactive. The pupil will not respond to miotics, but responds to mydriatics. Although previous authors believe atonic pupil is secondary to damage of the iris sphincter muscles, the etiology remains unclear. In our cases, all patients had normally reactive pupil's one day postoperatively. Initial recognition of the onset of atonic pupil ranged from 8 to 38 days following cataract extraction; (pupillary size ranged from 5.5 -8.0 mm). Intraocular pressures on the first postoperative day ranged from 7 to 30. All cases, except one, were performed with retrobulbar anesthesia using a 50:50 mixture of xylocaine 4% and .75% marcaine. The topical cases used preservative free 1% xylocaine. Since Percival's initial description of his cases of atonic pupil, numerous mechanisms of atonic pupil have been proposed. They include: increased intraocular pressure postoperatively, toxin exposure, damage to the ciliary ganglion during retrobulbar injection, general anesthesia, iris sphincter trauma during surgery, mechanical vascular compression and iris sphincter ischemia. In our retrospective evaluation, we were unable to find a common etiology to determine the source of our atonic pupils. Therefore, we agree with Golnik and others that this event is multifactorial.
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