Cataract Surgery: Unstretched Small Pupil by Dr. Shawn Cohen

[@ColbyStewart1965]

I like this. I like the fact that you don't do any extra moves; ie: ring; hooks, or sphincterectomies. I put a video up and someone commented on why I didn't just put a ring or hooks in the eye. I explained that it wasn't a necessary step. Very good video.

[@DrShawnCohen]

Thank you very much. The less we touch and the fewer the steps, the better the eye does. Stretching breaks the blood-aqueous barrier permanently which wouldn't be a good idea in combined glaucoma or cornea cases, in uveitis or in patients on blood thinners. I think we both agree that we need every tool we can use to make surgery safer and the outcome better. I like it when I can turn a disadvantage into an advantage. The rhexxis is easier for me because it runs less in a small pupil. The loose zonule cases move less and the vision the next day is better. I don't use steroidal drops when I don't stretch the pupil. Thanks for your support!

[@bkomur]

How you sure that iol goes to the bag ? In these cases I always doubt IOL goes to sulcus, and i strecth iris with a manupilator and under the iris saw that it finds a way to go bag. Are there useful tips about that point...thanks...

[@DrShawnCohen]

Great question because at time point 3:25 in the video it isn't obvious but I am filling the bag only, not the A/C, as this ensures that the bag has a deep pocket to accept the lens. If you fill the A/C first, the weight of viscoelastic can push down on the anterior capsule and collapse the bag. By inflating from a lower position, even lower than I went on the video, you swell the bag wide open. From that point, you can directly visualize the lens sliding deep into the bag. Push down on it to ensure its fixation into the bag. If movement of the patient is a concern during inflation, you can always enter the eye via the smaller stab incision, rather than the main wound. Thank you so much for your question because it isn't obvious from the video how to do this.

[@thiago88smart]

Hello dr. Shawn, I have a friend who suffered a blunt trauma to his left eye from an airsoft BB.... I saw his pupil got detached from its natural position and also he got cataracts from the trauma. Is it possible to have a 100% recovery?

[@DrShawnCohen]

I hope so. If the back of the eye (retina) is not damaged and there is no pressure problem, he should do well. Sometimes the lens could be loose from the trauma so the surgeon will have to be very careful with that. Also, be aware that sometimes removing the cataract can cause glare because the missing pupil isn't there to filter out the new brightness. Best of luck and health to you and your friend!