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Management of Small Pupil During Cataract Surgery


Dr Sudhir Singh
Sr. Consultant  & HOD
JW  Global  Hospital Research Centre
Mount Abu  India  307501

Case 1 : Manual Small Incision Cataract Surgery Through Post Uveitis 1mm Small Bound Down Pupil : No Hooks No Rings

In this case pupil was not getting dilated due to massive iridocapsular adhesions.
Iridocapsular adhesions between posterior surface of the iris and anterior surface of the anterior capsule try to broken with help of the iris spatula. But could not be succeed due to massive iridocapsular adhesions iris hooks and pupil expenders would not be useful.
So we decided to do multiple small sphincterotomies in the lower half of the pupilary sphincter with the help of vannas scissors. The Cane opener capsulotomy is done with 26 gauze needle capsulotome as capsulorhexis is not possible. The nucleus is rotated within the capsule using a Sinskey’s hook. The nucleus was prolapsed into anterior chamber using a Sinskey’s hook. Then the  nucleus is taken out with the help of a lens loop.The cortical matter cleaned up. Anterior chamber  was formed by viscoelastics. The IOL was implanted. The anterior chamber was washed up. The conjunctival flap reposited. The sub conjunctival gentamycin and dexamethasone injection given.


Case 2:Complicated Cataract Management With Non Dilating Pupil: No Hooks No Ring Approach

This was a post post uveitis complicated cataract with non dilated pupil. This case managed by my “No Hooks No Ring Approach”. This approach consistently works well for me in all types of the non dilating  pupils. Please watch out video for more details



Case 3:Phacoemulsification Through Post Uveitis 1mm Small Bound Down Pupil : No Hooks No Rings


Case 4:Phaco In White Hard Cataract In Non Dilated Pupil


Case 5: Intratunnel Phacofracture SICS In Floppy Iris and Non Dilating Pupil (With Commentary)


Case 6: MSICS In Pseudoexfoliation And Non getting Dilated Pupil (With Commentary)


Case 7:Manual SICS in Hyper Mature Cataract and Non Dilating Pupil


Case 8 : Temporal SICS in Post Trabeculectomy Non Getting Dilated Pupil


Intratunnel Phacofracture Manual Small Incision Cataract Surgery (MSICS) Video

Manual Small Incision Cataract Surgery (MSICS or Manual SICS) Video


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Important Links
Cataract Surgery In Small Pupil : No Hooks No Rings NEW
Difficult Cataract Cases Scenario Made Easy NEW
Manual Cataract Refractive Surgery 
Without Toric IOLs or Multifocal IOLs
Hard Nuclear Cataract Management


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