Intraoperative Challenges with Pupil Dilation Techniques | Cataract Mentors

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In a seemingly routine cataract surgery where we can almost visualize the incoming steps we have a surprise in the form of intraoperative miosis. The pupil loses its mydriatic tone and starts becoming smaller.
Poor pupillary exposure can lead one to turn a soft cataract into a crater and reach out to nuclear periphery to catch hold of the nucleus, and inevitably cause a dreaded PC rent. In such cases always use intracameral mydriatic ( epitrate used here- no financial interests ) to dilate the pupil and have better visualization during surgery. We can also use pupil dilating devices like rings and hooks or even viscoelastic agents which are helpful in plastic pupils. Then, even if we have a soft cataract which turns into a bowl or a crater we can easily tackle the same due to better pupillary exposure. Intracameral mydriatic usage is a simple but essential step in the completion of this surgery, and an important take clinic message.

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