EC Ophthalmology

Phacoemulsification cataract surgery requires adequate pupillary dilation to ensure safe and effective performance, particularly during the creation of a continuous curvilinear capsulorhexis (CCC). However, in certain clinical situations, sufficient dilation may be difficult to achieve or deliberately avoided, such as in patients with Intraoperative Floppy Iris Syndrome (IFIS) [1], advanced diabetes, or narrow-angle glaucoma [5]. This study evaluates a novel technique termed under-iris capsulorhexis, in which the capsulorhexis is created beneath the iris plane in eyes with small or non-dilating pupils [2,4]. The iris serves as a structural support, while the contrast between the stained and unstained anterior capsule provides a reliable visual guide. A total of 850 eyes underwent cataract surgery using this technique, demonstrating high safety and efficacy without major intraoperative or postoperative complications. The technique also showed particular benefit in patients with narrow-angle glaucoma [5], offering a practical alternative in settings lacking mechanical pupil expansion devices [4].

 Keywords: Cataract Surgery; Phacoemulsification; Small Pupil; Under-Iris Capsulorhexis; IFIS; Narrow-Angle Glaucoma

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2. Vasavada AR and Singh R. “Phacoemulsification in eyes with small pupils”. Journal of Cataract and Refractive Surgery 8 (2000): 1210-1218.
3. Masket S. “Preventing complications in small pupil cataract surgery”. Ophthalmology6 (2006): 1010-1015.
4. Gupta S and Ram J. “Management of poorly dilating pupils during cataract surgery”. Indian Journal of Ophthalmology 12 (2017): 1338-1345.
5. Hashemi H and Khabazkhoob M. “Cataract surgery in narrow-angle patients: risks and precautions”.