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Cataract Surgery Complicated by the Miotic Pupil

Samuel Masket, MD

Click on each slide to view a larger image.

	Slide 1. Postoperative view of surgically enlarged pupil with aesthetic and functional deficiencies.
	Slide 2. Slit lamp photograph of pseudoexfoliative changes noted on the pupillary margin. Pseudoexfoliation is a common cause of poorly dilating pupils.
	Slide 3. Lysis of pupil synechiae with a blunted spatula.
	Slide 4. Postoperative appearance after surgery including "pupil stretch." An iris hematoma is noted. This minor aesthetic deformity simulates an iris nevus.
	Slide 5. Postoperative appearance following a combination of pupil stretch and mini-sphincterotomies. Note that the pupil is normal in size and appearance.
	Slide 6. Disposable hook for enlarging the pupil. (Slide courtesy of Grieshaber, Inc.)
	Slide 7. Schematic representation of hook induced iris contact with phacoemulsification tip. Potentially this leads to mechanical and thermal damage of the iris during phacoemulsification.
	Slide 8. Postoporative view following prolonged phacoemulsification of a dense cataract during which iris hooks were employed. Notice the significant loss of superior iris tissue as a result of thermal and mechanical trauma.