Nucleofractis phacoemulsification through a small pupil.

A small pupil is an added risk with any technique for cataract extraction. A prospective study involving 1880 consecutive cataract procedures performed by one surgeon between January and June 1990 was carried out to determine the incidence of small pupils (preoperative diameter of 4 mm or less) and the surgical risk with phacoemulsification and implantation of an intraocular lens (IOL) "in the bag." Thirty eyes (1.6%) were found to have a small pupil. All 30 eyes received an in-the-bag posterior chamber IOL, with no intraoperative complications such as anterior or posterior capsule tears. The need for iris-enlarging surgery was correlated with pupil size: such surgery was done in O of the 10 eyes with pupils measuring 4 mm, 1 of the 12 eyes with pupils measuring 3 to 3.5 mm and 4 of the 8 eyes with pupils measuring 2 to 2.5 mm. The author proposes that opening the capsule with a continuous tear and removing the cataract by means of phacoemulsification with nuclear fracturing (nucleofractis) constitutes safe, efficient surgical management of eyes with small pupils undergoing cataract extraction.