Purpose To determine the rate and risk factors of vitreous loss during phacoemulsification in patients with cataracts operated by ophthalmology residents and fellows at Labbafinejad Medical Center. Methods This prospective descriptive study included consecutive patients with cataracts undergoing phacoemulsification over a one year period. All patients were operated under local or general anesthesia using the divide and conquer technique. Preoperatively, all patients underwent a complete ocular examination including measurement of visual acuity, slitlamp biomicroscopy, intraocular pressure measurement, and dilated funduscopy. Main outcome measures included the rate of posterior capsular rupture and vitreous loss as well as associated risk factors such as surgical experience, ocular and systemic conditions, and type and severity of the cataract. Results Overall, 767 eyes of 767 patients with mean age of 63.7±10.3 (range, 25–91) years were operated. The overall rate of vitreous loss was 7.9% which was 5-fold greater in the hands of residents as compared to fellows. Among different factors, older age, female sex, small pupil, small capsulorrhexis, presence of pseudoexfoliation, and high myopia were significantly associated with vitreous loss. The highest rate of vitreous loss occurred in patients with dense nuclear cataracts. Conclusion Considering the higher rate of vitreous loss in patients operated by ophthalmology residents; patients with known risk factors for vitreous loss should better be operated by more experienced surgeons.

To evaluate the benefits of using the Perfect Pupil expansion device (Becton Dickinson Ophthalmic Surgical) for cataract surgery. Eye Laser Center, Tucson, Arizona, USA. 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. 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. 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.

This paper presents the review of historical aspects and the current state-of-the-art in various pupil dilatation methods to be used in cataract surgery. The surgical algorithm in managing small pupil cases should include topical and intraocular mydriatics, appropriately selected viscosurgical device and mechanical dilatation with instruments, iris hooks, and/or pupil expanders.