Postoperative Pupil Size Research Articles

Thirty-gauge needle-guided purse-string suture pupilloplasty: a new technique

AIM: To observe the clinical outcomes of 30-gauge (G) needle-guided 10-0 prolene suture purse-string pupilloplasty for atonic pupil management. METHODS: Eight patients with atonic pupils who underwent suture purse-string pupilloplasty were retrospectively analyzed. Preoperative data and at least 6mo of postoperative data were collected from all the patients. RESULTS: The corrected distance visual acuity (CDVA) before and after surgery was 0.58±0.22 and 0.20±0.10 logMAR, respectively (P=0.002). The pre- and postoperative pupil size was 7.38±0.88 and 3.09±0.71 mm (P=0.000), respectively. The corneal endothelial cell count was 2841±176/mm2 before and 2692±143/mm2 after surgery (P=0.000). No intraoperative or postoperative complications were reported. During the follow-up period of at least 6mo, all treated pupils were centered and generally or nearly round. Furthermore, the patients did not exhibit photophobia, glare, or diplopia. CONCLUSION: This technique is a simple and effective method for pupil reduction.

Optimum pinhole size determination in pinhole pupilloplasty for higher-order aberrations.

To determine optimal pinhole size (OPS) and establish a relationship with visual acuity (VA) and RMS (root mean square) values in cases with higher-order aberrations (HOAs) undergoing pinhole pupilloplasty (PPP). Private practice, India. Prospective, interventional study. RMS value for 6-mm-diameter optical zone was determined by Scheimpflug imaging (Pentacam). Patients with RMS value >0.3 μm were included. Preoperatively, a hand-held pinhole gauge with varied apertures determined the OPS, and single-pass four-throw technique was used to perform pupilloplasty with Purkinje-1 reflex as a marker for centration. VA with OPS, correlation of RMS values with OPS and pupil size, and Strehl ratio were the main outcome measures. 29 eyes with HOAs were analyzed; all patients chose 1.0 or 1.5 mm as OPS. The mean preoperative and postoperative pupil size was 3.25 ± 0.81 mm and 1.8 ± 0.54 mm ( P = .000), respectively. Postoperative mean pupil size when compared with OPS denoted that 14 eyes had a difference of <0.1 mm, 8 eyes ranged from 0.2 to 0.45 mm, and 7 eyes had ≥0.6 mm (range from 0.6 to 1.8 mm) difference from OPS. Eyes with higher RMS values needed smaller pupil gauge to achieve better VA. Preoperatively, vision with OPS correlated well with preoperative 6-mm RMS HOAs ( r = 0.728; P = .00). Postoperative UDVA correlated well with VA measured with OPS ( r = 0.847; P = .00). The preoperative and postoperative mean Strehl ratio was 0.109 ± 0.07 and 0.195 ± 0.11 ( P = .001), respectively. Higher RMS values required a smaller pupil to achieve optimum VA. PPP can help achieve pinhole size in accordance with patient's optimum pinhole requirement.

Comparison of pupil expansion devices in small pupil phacoemulsification.

To study the outcomes of phacoemulsification in small pupils (≤4 mm) using pupil expansion devices at a tertiary eye care center in South India. The study design is prospective, randomized, comparative, and interventional. Mechanical pupil dilatation with iris retractors (group I), B-HEX ring (group II), and Gupta ring (group III) was compared with respect to pupil size achieved (intraoperative), total surgical time, device addition time, complications, endothelial cell loss, and postoperative best corrected visual acuity. Among 36 participants (12 in each group), the mean pupil size, total surgical time, and device addition time were maximum with iris retractors. Intraoperatively, sphincter tear was seen in two eyes in the iris retractors group and one eye in the Gupta ring group. In the B-HEX ring group, only two flanges of the ring could be engaged in two participants, one patient had iris bleeding (during stretching of the iris), and one patient had anterior lens capsular tear. Among all three groups, there was no statistically significant difference in best corrected visual acuity (BCVA), endothelial cell count, and coefficient of variation obtained in the preoperative period, postoperative Day 7 and Day 30, respectively. In our study, in more than 50% of cases, the cause of small pupil was idiopathic/senile. Among nonidiopathic causes, PXF was the most common association. Although iris retractors are cost-effective and give maximum intraoperative dilatation, there is a need of four additional side ports to be made, thus increasing the total surgical time and device addition time. On the other hand, B-HEX and Gupta ring provide comparable intraoperative dilation and device addition time and also have comparable postoperative outcomes in terms of postoperative pupil size and complications.

Changes in Chord Mu (µ) Length Before and After Cataract Surgery

Aim: Comparison of chord  length, a potential marker that may gain importance especially in multifocal lens implantation, before and after phacoemulsification surgery and intraocular lens (IOL) implantation in patients with cataracts. Methods: This retrospective study included 33 eyes of 33 patients who underwent phacoemulsification surgery between December 2022 and February 2023. Corneal topography (Pentacam HR, Oculus, Wetzlar, optikgerate GmbH) was performed on each patient before and after surgery. The values obtained before and at least 3 months after surgery were compared using the Student-t test. Results: There were 18 (54.5%) males and 15 (45.5%) females among the 33 patients who participated in the study. The average age was 67.27 ± 10.93 years. The postoperative mean chord μ lenght was significantly lower than the preoperative mean chord μ lenght (p=0.002). Additionally, the mean postoperative pupil size was significantly lower than the mean preoperative pupil size (p=0.000). There is a weak positive relationship between the change in chord μ length and the change in pupil size, but this relationship is not statistically significant (p&gt;0.05). No statistically significant relationship was found between any of the other binary variables. Conclusion: Centralization is crucial in refractive surgery and multifocal IOL implantation to prevent high-order aberrations and photic phenomena. Therefore, it seems useful for surgeons to be familiar with chord μ measurements, especially regarding surgical preparation. It should be considered that changes in chord mu values may influence the development of photic phenomena. A decrease in chord mu after phacoemulsification may assist the surgeon in the preoperative decision-making process in patients at risk of photic phenomena or in patients with borderline values.

Liberty® by Medicontur, a Complex in Structure, Hydrophilic Intraocular Lens in the Correction of Eyes with Preoperative Myopia

A retrospective analysis of visual function in patients with preoperatively diagnosed myopia, after implantation of Liberty® intraocular lens, including the influence of some factors like a kind of surgery, values of angle alpha and kappa, pupil size, values of higher order aberrations generated by the lens on visual acuity to far and near distances was done. Lens removal and Liberty® implantation was done 47 eyes, including in 13 patients in both eyes. In 7 eyes, it was a toric lens. A mean preoperative value of myopia was -6.72 Dsph. Cataract removal accounted for 55% of all procedures performed, the rest being Refractive Lens Exchange. Preoperative pupil size was between 3.6 and 6,4 mm. The average postoperative visual acuity to far distances was 0.13 (logMar), and to near distances was 0.51 (Snellen). Rare cases of insufficient quality of vision to intermediate distances, when the postoperative pupil size was greater than 4 mm, resolved after increasing light intensity in the room. A bigger values of higher order aberrations corresponded with lower values of preoperative visual acuity to far distances. A bigger values of angle alpha corresponded with lower values of postoperative visual acuity to far distances, which were significantly higher in cataract group. Visual acuity to far distances was also better in eye with bigger pupil size. A specific structure of the lens allows patients to see good to the near distances, even if the light intensity not perfect.

The Effect of Age, Postoperative Refraction, and Pre- and Postoperative Pupil Size on Halo Size and Intensity in Eyes Implanted with a Trifocal or Extended Depth-of-Focus Lens.

PurposeHalos are a chief source of patient dissatisfaction after multifocal intraocular lens (IOL) implantation. The primary purpose of this study was to investigate the influence of age, postoperative refraction, and pre- and postoperative pupil size on postoperative halo size with a trifocal diffractive IOL (AcrySof IQ PanOptix) and extended depth-of-focus (EDOF) IOL (TECNIS Symfony) to determine whether these factors could predict postoperative halo size.Patients and MethodsThis single-center, open-label study conducted between October 2018 and April 2020 in Yokosuka, Japan included 160 patients: 80 with PanOptix and 80 with Symfony IOLs. Size and intensity of the halos were examined binocularly using a computer-based simulator (Eyeland Design Network GmbH) and scored from 0 (minimum) to 10 (maximum) at 1, 3, and 6 months postoperatively, along with the change in each variable for both IOLs. The respective correlations of halo size with age, postoperative refraction, pre- and postoperative pupil size, and discomfort level due to the halo were also investigated 6 months postoperatively.ResultsHalo size and intensity were significantly mitigated between 1, 3, and 6 months postoperatively. Throughout the observation period, halo size was significantly larger with PanOptix than with Symphony (P < 0.05), and halo intensity was significantly higher with Symphony than with PanOptix (P < 0.05). The pre- and postoperative pupil size correlated positively with halo size, while age and postoperative refraction were negatively correlated, for both IOLs.ConclusionUnderstanding the features and predictive preoperative factors of halos in different types of multifocal IOLs may be useful in improving patient satisfaction.

Pupil cerclage technique for treatment of traumatic mydriasis.

The aim of this study is to evaluate the efficacy of pupil cerclage and a new variant of sliding knot technique for repairing traumatic mydriasis. This is a observational case series study. A series of consecutive patients affected by traumatic permanent mydriasis who underwent pupil cerclage were recruited at the Department of Ophthalmology of the University of Padova, Italy. Best-corrected visual acuity, measured in logarithm of minimum angle of resolution (logMAR), and intraocular pressure at 1, 3, 6, and 12 months were monitored. Postoperative pupil size and anterior chamber angle were measured. Postoperative cystoid macular edema (CME) and glaucoma were evaluated. Twelve patients were recruited. Phakic patients (7) underwent cataract surgery combined with pupil cerclage. Vitrectomy was performed in nine patients. Best-corrected visual acuity improved from 2.9 ± 1.1 logMAR at baseline to 0.3 ± 0.8 logMAR at 12th month. No significant difference between the preoperative and postoperative intraocular pressure was demonstrated. Mean pupil size at 12th month was 2.82 ± 0.5 mm with round shape. Anterior chamber angle mean was 47° ± 4.5°. Six patients developed a CME, and two patients a glaucoma. Pupil cerclage technique reestablishes the pupil with a precise regulation of the pupil size without distortion of its natural round shape. New sliding knot allows surgeon to reduce the risk of iatrogenic iris damage and to make a security permanent knot.

Assessment of differences in pupil size following phacoemulsification surgery

Purpose:The purpose of this study is to detect the changes in pupil size developing after phacoemulsification surgery.Methods:Seventy-five eyes of a total of 49 patients (32 males and 17 females) were included in this prospective clinical trial. Routine preoperative ophthalmological examinations of the patients were performed. The presence of any systemic diseases, the presence or history of ocular trauma, uveitis, optic neuropathy or anisocoria, using ocular or systemic medications, and also the presence of any other serious ocular diseases except cataract was considered as criteria for exclusion. The age range of patients included in the study is 48–81 years. Patients who developed surgical complications were excluded from the study. Pupil measurements were made after each patient waited in a dark room for 5 min preoperatively and were repeated 1 month after the operation. The Oasis brand of pupillometer was used for pupil measurement.Results:The mean, standard deviation, median, minimum-maximum, ratio, and frequency were used for the descriptive statistics of the data. Postoperative pupil size was seen to significantly decrease compared to the preoperative period (P < 0.05). The mean value of preoperative pupil size decreased from 4.9 ± 1.0 to 4.1 ± 0.9 mm 1 month after operation.Conclusion:The pupil size is important in phacoemulsification especially combination with phacoemulsification and multifocal intraocular lens implantation. It should be considered that better postoperative visual outcomes would be obtained by accompanying postoperative pupil size reduction into preoperative measurements. Thus, we recommend MIOLs that function independent of pupil size as appropriate for cataract surgeries in elderly patients.

Pupil response to tropicamide following corneal crosslinking.

To evaluate the effect of corneal crosslinking (CXL) with ultraviolet A (UVA) irradiation on pupil response to tropicamide 0.5% instillation. This prospective interventional study enrolled 17 patients (19 eyes) with progressive keratoconus who underwent CXL with UVA irradiation. Central corneal thickness (CCT) was evaluated with the use of anterior segment optical coherence tomography (Visante OCT 3.0). Pupil diameter was measured with the use of Colvard infrared pupillometer before the instillation of tropicamide 0.5% and after the instillation of tropicamide every 5 minutes for total duration of 30 minutes. Corneal epithelial integrity was examined with the use of fluorescein dye staining. Measurements were performed 1 day preoperatively and 1 month postoperatively, with emphasis on simulating the same light conditions regarding the pupil measurements. No intraoperative or postoperative complications were observed in any of the patients. Mean CCT decreased significantly (p&lt;0.001) 1 month postoperatively. Mean postoperative pupil size did not change significantly at any time point compared to the mean preoperative measurements. The CXL procedure seems not to impair effectiveness of topical drugs, using pupil size measurements after tropicamide 0.5% instillation.

Retrospective evaluation of the influence of pupil size on visual acuity after KAMRA inlay implantation.

To investigate the influence of pupil size on visual acuity after KAMRA inlay (AcuFocus, Inc., Irvine, CA) implantation. Five hundred eighty-four presbyopic eyes of 584 patients who underwent LASIK were evaluated. Uncorrected near visual acuity (UNVA), uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and corrected near visual acuity (CNVA) were measured. Two groups were classified: small pupil (pupil diameter < 6 mm) and large pupil (pupil diameter ≥ 6 mm) for both mesopic (pupil diameter < 4 mm) and photopic (pupil diameter ≥ 4 mm) pupil size parameters. The follow-up period was 6 months. There were no significant differences in UNVA (P = .98) and CNVA (P = .16) between the mesopic pupil size groups; however, there were significant differences in UDVA (P = .023) and CDVA (P = .039). There was a weak correlation between pupil size and UDVA of the large mesopic pupil size group (rs = 0.129, P = .04). There were no significant differences in UNVA (P = .78), CNVA (P = .92), UDVA (P = .19), and CDVA (P = .60) for the photopic pupil size groups. Pupil size does not have an influence on the resultant visual acuity after KAMRA inlay implantation. No correlation was found between preoperative and postoperative pupil size and visual acuity for the mesopic pupil groups.

Evaluation of anterior segment parameter changes using the Pentacam after uneventful phacoemulsification

This study set out to evaluate the influences of uneventful phacoemulsification on the anterior segment parameters obtained with the Pentacam rotating Scheimpflug camera and intraocular pressure (IOP). A total of 42 eyes of 34 patients (26 men, eight women) were evaluated preoperatively, and at 1, 3 and 6 months postoperatively with the Pentacam. Intraocular pressure was measured with the Goldmann applanation tonometer. The non-parametric paired t-test was used to compare preoperative and 1-, 3- and 6-month postoperative measurements of anterior chamber depth (ACD), anterior chamber volume (ACV), anterior chamber angle (ACA) width, central corneal thickness (CCT), the central 3-, 5- and 7-mm corneal volume (CV), pupil size, and IOP. Pearson's correlation test was used to evaluate the relationships between IOP and ACD, ACV and ACA width. The differences between ACD, ACV, ACA and IOP values taken preoperatively and those taken postoperatively at 1, 3 and 6 months were statistically significant (p<0.05). The differences between CCT, central 3-, 5- and 7-mm CV, and pupil size measurements taken preoperatively and those taken postoperatively at 1, 3 and 6 months were not statistically significant (p>0.05). The decrease in IOP was not correlated with the changes in ACD, ACV and ACA (p>0.05). Uneventful phacoemulsification significantly reduced IOP, increased ACD and ACV, and widened the ACA. However, alterations in CV, CCT and pupil size values were not statistically significant. Alterations in ACD, ACV, ACA and IOP remain stable after the first month of surgery.

Change in pupil size after implantation of an iris-fixated toric phakic intraocular lens

To evaluate the changes in pupil size after implantation of an iris-supported toric phakic intraocular lens (TPIOL) for correction of myopia and hyperopia with astigmatism. Department of Ophthalmology, Johannes Gutenberg-University, Mainz, Germany. Twenty-two myopic eyes and 9 hyperopic eyes were included in the study. The mean age of the 2 groups was 34 years and 40 years, respectively. The scotopic pupil size was measured with a handheld infrared pupillometer (Colvard, Oasis Medical) before and 6 months after implantation of the TPIOL. All examinations were performed under scotopic conditions after 2 minutes of dark adaptation with the fellow eye covered. Intraindividual comparisons were made between preoperative and postoperative pupil sizes. The relationship between implanted IOL power and postoperative pupil width in each group was studied to determine whether lens magnification could lead to misinterpretation of the results. The difference between horizontal and vertical postoperative pupil diameters was assessed in eyes with horizontally aligned IOLs to determine the potential mechanical effect of the TPIOL on pupil size. The mean scotopic pupil diameter decreased significantly from 4.7 mm (range 3.0 to 6.0 mm) preoperatively to 3.6 mm (range 2.0 to 5.0 mm) postoperatively in myopic eyes and from 5.0 mm (range 4.0 to 6.0 mm) to 4.0 mm (range 2.0 to 5.0 mm) in hyperopic eyes. No significant correlation between the power of the TPIOL and the postoperative pupil size diameter was found, confirming that the IOL did not distort measurements of pupil size. Comparing horizontal and vertical pupil diameters under medical mydriasis revealed reduced pupil size in the axis of enclavation. The scotopic pupil diameter decreased by a mean of 1.1 mm in myopic eyes and 1.0 mm in hyperopic eyes after implantation of the iris-supported TPIOL. Postoperative pupil size was not related to IOL power, patients' emotional states, or other factors. The slightly smaller pupil diameter in the axis of enclavation suggests that this fixation method restricts pupil size under scotopic conditions, which could reduce the incidence of postoperative photic phenomena.

Pupil size before and after phacoemulsification in nondiabetic and diabetic patients

To evaluate the changes in pupil size before and after phacoemulsification surgery in nondiabetic and diabetic patients and determine whether there is an association between preoperative pupil size and postoperative pupil size. Hayashi Eye Hospital, Fukuoka, Japan. In this study, 315 nondiabetic patients and 71 diabetic patients scheduled for phacoemulsification were recruited consecutively. The pupil area and pupil diameter were measured preoperatively and approximately 3 days and 1 month postoperatively using an infrared pupillometer and Colvard pupillometer, respectively. The simple association between preoperative and postoperative pupil size and between pupil size and age were evaluated. The mean pupil area in the nondiabetic group and diabetic group decreased significantly 3 days postoperatively and returned to approximately preoperative levels at 1 month. Strong associations were found between preoperative pupil area and diameter and the area and diameter at 3 days and 1 month in both groups. Younger age was weakly associated with larger pupils in the nondiabetic group. The pupil size in the diabetic group was smaller than in the nondiabetic group, although the difference was not significant preoperatively. The pupil size became smaller with increasing severity of diabetic retinopathy. Pupil size decreased immediately after phacoemulsification but returned to approximately preoperative levels by 1 month postoperatively in nondiabetic and diabetic patients. There was a strong association between preoperative and postoperative pupil size. The pupil size in diabetic patients was significantly smaller than in nondiabetic patients postoperatively.

Changes in pupil size induced by phacoemulsification and posterior chamber lens implantation: consequences for multifocal lenses

Abstract Purpose: Because the optical performance of eyes implanted with multifocal intraocular lenses will theoretically depend upon the size and position of the pupil relative to the near and distance zones of the lens, we designed a study to determine whether preoperative pupil size is useful in predicting the postoperative pupil size of patients having phacoemulsification with posterior chamber lens implantation. Setting: Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas. Methods: We prospectively measured pupil sizes preoperatively and postoperatively in 71 consecutive patients who had phacoemulsification with posterior chamber lens implantation. Pupil sizes were photographed under five lighting and viewing conditions that simulated a range of normal functional situations. Results: The mean change in preoperative to postoperative pupil size was less than 0.5 mm in all five testing conditions. However, changes in pupil diameter of 1.0 mm or more were noted in approximately 10% of patients in each testing situation. Sex, iris color, and the presence or absence of intraoperative iris trauma were not predictive factors for determining which patients sustained large postoperative changes in pupil size. Conclusions: Preoperative pupil size does not predict postoperative size with sufficient consistency to ensure a good match between pupil diameter and the zone sizes of multizone multifocal intraocular lenses.

Changes in pupil size induced by phacoemulsification and posterior chamber lens implantation: Consequences for multifocal lenses

Purpose: Because the optical performance of eyes implanted with multifocal intraocular lenses will theoretically depend upon the size and position of the pupil relative to the near and distance zones of the lens, we designed a study to determine whether preoperative pupil size is useful in predicting the postoperative pupil size of patients having phacoemulsification with posterior chamber lens implantation.Setting: Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas.Methods: We prospectively measured pupil sizes preoperatively and postoperatively in 71 consecutive patients who had phacoemulsification with posterior chamber lens implantation. Pupil sizes were photographed under five lighting and viewing conditions that simulated a range of normal functional situations.Results: The mean change in preoperative to postoperative pupil size was less than 0.5 mm in all five testing conditions. However, changes in pupil diameter of 1.0 mm or more were noted in approximately 10% of patients in each testing situation. Sex, iris color, and the presence or absence of intraoperative iris trauma were not predictive factors for determining which patients sustained large postoperative changes in pupil size.Conclusions: Preoperative pupil size does not predict postoperative size with sufficient consistency to ensure a good match between pupil diameter and the zone sizes of multizone multifocal intraocular lenses.

Relationship between postoperative pupil size and disability glare

A group of 40 postoperative cataract patients had Miller-Nadler glare testing performed before and after midpupillary pharmacologic dilation. The results indicated that pupillary enlargement is associated with increased glare disability. For that reason it is essential to maintain normal pupil shape and function after cataract surgery, a difficult task in cases with miotic pupils.