Cataract surgery is one of the most frequently performed eye surgery. There have been many technological advances that have helped improve outcomes. A cataract is anatomically located behind the pupil. In order to access the cataract at the time of surgery the pupil must be fully dilated. There are conditions that prevent the full dilation of the pupil. Since the pupil is a neuromuscular structure health conditions affecting the nerves and muscles (diabetes, neuropathy, pseudoexfoliative syndrome and other neurological disorders) could prevent the pupil from dilating beyond a certain point. Other conditions that may prevent dilation happen after ocular inflammations. Scaring of the pupil to the lens (posterior adhesions/synechiae) can develop after injuries, uveitis, iritis or other inflammatory eye conditions. Small pupils may be encountered with the use of several medications (long-term use of miotics or alpha blockers like Flomax/Tamsulosin) and potentially cause challenges during cataract surgery. Alpha-blocker class include terazosin (Hytrin®), doxazosin (Cardura®) and alfuzosin (Uroxatral®). It is important patients provide a comprehensive list of medications used in the past in addition to the ones used presently.
If dilating drops cannot achieve dilation it may be necessary to use intraocular pupil expansion devices such as a Malyugin Ring (technique demonstrated by the inventor)
Once the cataract procedure is complete these devices are removed usually without creating any significant additional postoperative issues