Device facilitates safe cataract surgery

Chicago-Insertion of the Perfect Pupil Injectable (PPI, Milvella Pty. Ltd.) is an effective method for protecting the iris and maintaining a large pupil during cataract surgery in eyes predisposed to intraoperative floppy iris syndrome (IFIS), according to the results of an interventional case series reported at the annual meeting of the American Academy of Ophthalmology.

Dr. Milverton developed the PPI, is director of Milvella Pty. Ltd., and was the senior author of this study, which was performed at the Intraocular Implant Unit, Sydney Eye Hospital, Sydney, Australia. His co-author, Suresh K. Pandey, MD, Sydney Eye Hospital, reported the results at the annual meeting of the American Academy of Ophthalmology.

Results from the fellow eyes showed viscomydriasis with Healon 5 was effective for enlarging the pupil to a diameter of about 6.0 mm. However, progressive intraoperative miosis occurred during a phaco chop procedure, which was performed using high vacuum and flow rate parameters. A posterior capsule tear with vitreous loss occurred in one of the six eyes (17%). The visual outcomes at 3 months showed two eyes achieved 20/20 BCVA, three eyes were 20/30, and one had BCVA of 20/40.

Challenges with viscomydriasis

"When using Healon 5, the pupil may begin to constrict intraoperatively due to premature evacuation of the viscoelastic. Therefore, it is recommended that this method of viscomydriasis be used with a low aspiration flow rate and low vacuum and perhaps by surgeons accustomed to operating with those settings," Dr. Pandey said.

The patients included in the study were all older males (65 to 81 years) being treated with tamsulosin for benign prostatic hyperplasia. They had all discontinued tamsulosin treatment 3 weeks prior to their first eye surgery and presented with variable degrees of IFIS during the procedure.

The six men were identified over a 6-month period during which a total of 300 consecutive patients were prospectively screened for tamsulosin intake.