A self-made disposable iris retractor in small pupil phacoemulsification

AIM:To explore a simple and low-cost self-made disposable flexible iris retractor and study its clinical efficacy and safety in small pupil phacoemulsification.METHODS:Polyproplyenesutureandscalpacupuncture were used to make iris retractor.A prospective study were carried on 50 patients(50 eyes)with a maximally dilated pupil size of 2.5-4.0 mm which underwent phacoemulsification using this self-made iris retractor.Another 50 cases of phacoemulsification with normal pupil size sever as control group.The mean operation time,ultrasound time and ultrasonic power,volume of irrigation fluid were documented intraoperatively.The visual acuity,pupil size and complication were observed on 1d,1wk,1mo and 1y after operation.Corneal endothelial cell was measured at 1mo postoperatively.·RESULT:Pupils could be expanded to approximately4.5-5.5 mm with our self-made iris retractor in operation.No serious postoperative complication was found.Most(88%)of the pupils returned round or oval shape,light reflex restored to varying degrees at the first day after surgery.Best corrected visual acuity stabilized in 37 eyes(74%)at one day,in 43 eyes(86%)at one week,in 44eyes(88%)at one month and 46 eyes(92%)at one year.Compared with the control,more time was needed to complete the operation in the small pupil group.There was no significant difference of the mean ultrasound time,ultrasonic power,volume of irrigation fluid requiredand corneal endothelial cell loss in 1mo follow up between the two groups.CONCLUSION:Our self-made disposable flexible iris retractor could be easy obtained preoperatively or intraoperatively.It performed both safety and efficacy in our clinical trials.This simple self-made device has shown economic and practical values,especially in primary care hospital of the less developed districts.

Evaluation of traumatic retinopathy with ultra-wide field imaging under corneal scar or fixed small pupil

AIM： To evaluate the value of ultra-wide field（UWF） imaging in the management of traumatic retinopathy under the condition of corneal scar or fixed small pupil after complicated ocular trauma. METHODS： Twenty-eight patients（28 eyes） with complicated ocular trauma were enrolled in the study from June 2016 to May 2017, including 19 males and 9 females with age ranged from 11 to 64（43.42±12.62）y. All patients were treated with secondary vitrectomy after emergency operation for wound repair of open ocular trauma. Direct ophthalmoscopy and 45-degree fundus photography were taken at each time point of follow up for comparison of findings with UWF images. Routine eye examination including visual acuity, intraocular pressure, slit lamp examination were performed and analyzed as well.RESULTS： Among the 28 traumatized eyes, the positive rate for identification of traumatic retinopathed was 32.1%（9 cases）, 14.9%（5 cases）, and 85.7%（24 cases） with direct ophthalmoscopy, 45-degree fundus photography, and UWF imaging, respectively. The detective rate of UWF imaging under the condition of corneal scar or fixed small pupil was statistically greater than that of 45-degree fundus photography and direct ophthalmoscopy（Bonferroni correction, P〈0.001）. UWF image was obtained in 19 eyes with opaque corneal scar, otherwise their fundus could not be seen by conventional methods. The additional findings of traumatic retinopathies by UWF imaging included periretinal membranes or pre-retinal proliferating strip, retinal holes, hemorrhage in the vitreous or sub-retinal space.CONCLUSION： UWF imaging is superior to traditional fundus photography in the evaluation of traumatic retinopathies under the condition of corneal scar or fixed small pupil after complicated ocular trauma.