How to handle a small pupil in combined surgery

June 15, 2003
Mark Packer, MD,FACS

Dr. Packer, is co-editor of Cataract Corner. He is assistant clinical professor of ophthalmology at Oregon Health & Science University and in private practice in Eugene.

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I. Howard Fine, MD

Dr. Fine is clinical professor of ophthalmology at Casey Eye Institute, Oredon Health & Science University and founding member of his practice, Oregon Eye Associates, Eugene.

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Richard S. Hoffman, MD

Dr. Hoffman is co-editor of Cataract Corner. He is a clinical associate professor of ophthalmology at Oregon Health & Science University and is in private practice in Eugene.

The pupil that dilates poorly is frequently associated with both glaucoma and complications during combined surgery. With newer endolenticular techniques, especially with nucleofractis procedures and chop techniques, pupils do not need to be as large as previously required.1-4 However, there still are numerous instances in which the pupil is inadequate to allow the surgeon to proceed, and some form of manipulation or surgery is required.