Sphicterotomy for small pupil : Phacoemulsification for beginners

• 08 May 2020
• Dr. Sourabh Patwardhan
• 2.4K
• 801

For Phaco training and fellowship contact patwardhan.sourabh@gmail.com
In this video, i will demonstrate sphincterotomy, which is used in the management of small pupil. It can be used in rigid non dilating pupil, but it is to be avoided in floppy iris. While cutting , do not go beyond the collarette , otherwise it can lead to fixed dilated pupil post operatively.In this case of pxf with small pupil, make small incisions to avoid wound leak. This is especially in this case because there can be tendency of iris to prolapse from larger wounds. Always use high viscosity dispersive viscoelastic like viscoat in this case because it maintains the anterior chamber and does not get washed away easily. Use vannas with blunt tip. Make 3 to 4 small nicks, do not go beyond the collarette.After doing sphincterotomy, again use high viscosity dispersive viscoelastic. In pxf cases, i generally use CTR prophylactically. During phaco, you can use routine settings. In case there are AC fluctuations, you can reduce the settings. Take care to stay away from the iris margin, particularly when the tip is not occluded by a nuclear piece to avoid catching the iris. In between the surgery, you can replenish the visco to keep the pupil dilated. You can see during the surgery, the pupil remains well dilated during the surgery. After the surgery, the pupil comes back to normal size. It remains dilated only if the cut was beyond the collarette.

Published By Dr. Sourabh Patwardhan

FRCS (UK), MS (AIIMS), DNB, MNAMS, FICO

Director, Nandadeep eye hospital, Sangli,India.
He heads a very popular Phaco training and fellowship program.