![]() But also we follow with intracameral injection of phenylephrine or epinephrine into the anterior chamber. We start with of course topical mydriatics. I do think that stepwise approach is the most logical and appropriate one. There are several techniques that can be used to manage small pupils in cataract surgery. And it is known that 1 millimeter of pupil which is abnormal, subnormal, 1 millimeter of pupil miosis increased the complication rate by roughly 10%. And it is also known for its association with the increased complication rate, such as iris trauma, capsular rupture, vitreous loss, inflammation, et cetera. Because it is very much associated with zonular pathology, blood-aqueous barrier disruption, intraocular pressure spikes, and so forth and so on. It’s also an indication of various systemic and local comorbidities. Small pupil is not only a geometrical issue. And it was introduced to ophthalmology by Karl Gustav Himly in his seminal work, which was published in 1831. One of them is belladonna, or as you know it, atropine. Later on, pharmacological substances were used. And as you can see here, iridectomy was one of the options at that time, to have a good access to the lens, to be able to extract it from the eye. For years, it was a big issue for cataract surgeons, and even for the ancient cataract surgeons. Very small pupil does not allow us to visualize what’s going on behind the iris, and does not give us a good access to the lens and to the lens capsule and capsule content. But also, the other major factor is the size of the pupil, as shown here. Visualization is very much decreased when we do have our problems with corneal transparency. However, I will focus today on visualization, which is one of the major things in cataract surgery to be discussed. There are many of them to be kept in mind. And of course, IOL design and fixation methods. Capsular stability and keeping capsular integrity. We need to talk about proper surgical maneuvers and visualization. We need to talk about optimal instrumentation and settings. We need to keep in mind several critical aspects of that surgery. There are ten of them, including some smaller outpatient clinics overall. And we see that the biggest number of clinics we do have located - is in the European part of the Russian Federation. ![]() This is the European part of Russia, which is much more populated than the Asian one. Actually, we have the major facility in Moscow, and also we do have affiliations all over Russia, as shown here. We have an educational facility, we have clinics, and a place where our patients can stay, short term. So this is the Fyodorov Eye Microsurgery Institution, as shown here. First of all, a little bit about myself and the institution. And I will be happy to share with you my experiences with pupil management in cataract surgery.
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