Management of the small pupil for clear corneal cataract surgery

Purpose: To evaluate the benefits of using the Perfect Pupil expansion device (Becton Dickinson Ophthalmic Surgical) for cataract surgery. Setting: Eye Laser Center, Tucson, Arizona, USA. Methods: Thirty patients whose pupils failed to dilate beyond 4.0 mm were selected to have the Perfect Pupil used during their cataract surgery. The Perfect Pupil was inserted through an unenlarged 2.8 mm clear corneal incision into the pupillary aperture. The capsulorhexis, hydrodissection, phacoemulsification, and injection of the intraocular lens were performed through the expanded pupil with the device in place. The pupil size before, during, and after surgery was measured. Results: The mean pupil size was 3.2 mm preoperatively, 7.8 mm after insertion of the device, and 4.3 mm after its removal. There were no cases of iris sphincter tear, bleeding, ruptured capsule, or irregular pupil postoperatively. Conclusions: The Perfect Pupil was beneficial during small-incision cataract surgery in cases in which the pupil failed to dilate adequately. The device was easy to insert and remove, expanded the pupil to approximately 8.0 mm, protected the iris sphincter during surgery, and allowed the pupil to return to its normal size, shape, and function postoperatively. (C) 2002 ASCRS and ESCRS.