title: Femtosecond laser-assisted cataract surgery in eyes with a small pupil.
abstract: OBJECTIVE
  To evaluate the efficacy of different treatment modalities in eyes with small pupils before femtosecond laser-assisted cataract surgery.
  
  
  METHODS
  Ruhr University Eye Clinic, Bochum, Germany.
  
  
  METHODS
  Prospective clinical trial.
  
  
  METHODS
  Eyes with an intraoperative pupil size smaller than 5.5 mm received sequential treatments to achieve a pupil larger than 5.5 mm in 3 steps: (1) intracameral administration of epinephrine solution, (2) additional viscomydriasis, and (3) implantation of a Malyugin ring pupil expander. When a step enlarged the pupil to at least 5.5 mm, femtosecond laser-assisted cataract surgery with an anterior capsulotomy diameter of at least 4.5 mm and 350 μm nuclear fragmentation grids, ultrasound phacoemulsification, and intraocular lens implantation were performed. Main outcome measures were achieved preoperative pupil size in each sequential treatment group and analysis of intraoperative complications.
  
  
  RESULTS
  Of 850 eyes scheduled for cataract surgery, 40 received sequential treatments. To achieve a pupil larger than 5.5 mm, epinephrine was sufficient in 7% of the eyes; additional viscomydriasis was necessary in 25%, and the pupil expander was implanted in 68%. The most frequent comorbidities were pseudoexfoliation of the lens capsule (30.0%) and intraoperative floppy-iris syndrome (12.5%). Tongue-like lesions of the capsulotomies were detected in 5 eyes.
  
  
  CONCLUSIONS
  The 3-step treatment allowed the surgeon to increase the efficiency and safety of femtosecond-assisted cataract surgery in eyes with a small preoperative pupil, providing good safety margins at the pupil boundary for the capsulotomy and the softened nuclear volume.
authors.affiliation: Ruhr University Eye Clinic, Bochum, Germany. ina.conrad-hengerer@kk-bochum.de
authors.forename: Ina
authors.initials: I
authors.lastname: Conrad-Hengerer
authors.forename: Fritz H
authors.initials: FH
authors.lastname: Hengerer
authors.forename: Tim
authors.initials: T
authors.lastname: Schultz
authors.forename: H Burkhard
authors.initials: HB
authors.lastname: Dick
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057866:Anterior Capsule of the Lens / Q000601:surgery; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D028022:Low-Level Light Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009184:Mydriatics / Q000008:administration & dosage; D018918:Phacoemulsification / Q000379:methods*; D019736:Prostheses and Implants; D011680:Pupil / Q000187:drug effects; D011681:Pupil Disorders / Q000150:complications / Q000601:surgery*; D025321:Surgery, Computer-Assisted; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D055675:Viscosupplements / Q000627:therapeutic use
chemical_list: D009184:Mydriatics; D055675:Viscosupplements; D004837:Epinephrine