Jeffrey Whitman, MD, president and chief
surgeon at the Key-Whitman Eye Center in
Dallas, Texas, says one-third of his patients
have pupils that don't fully dilate. In those
cases, he employs a single-use ring that gives
him plenty of room within the eye to manipu-
late instruments. He places the device over the
iris, so he's not stretching delicate eye anatomy
during insertion or mangling the iris during
removal.
• Pupil dilators. Dr. Whitman can also
reach for a reusable pupil dilator, which costs
about $400. He inserts the instrument through
a small incision and pushes a plunger to acti-
vate prongs, which engage the margins of the
pupil. The dilator cuts down on case costs
once it's been paid for, but Dr. Whitman cau-
tions that the device doesn't match the per-
formance of ring devices with respect to post-
op cosmesis of the iris. He also points out that
the dilator is removed for the remainder of
the procedure once the pupil has been
expanded. That, he says, increases the risk of
sucking up the edge of the iris during aspira-
tion of cortical material.
• Intraocular pharmacologic dilation.
Surgeons often inject an epinephrine-lidocaine
mixture into the anterior chamber to initiate
pupil dilation with the hope that the injection
will keep the pupil from constricting during
1 0 2 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • F E B R U A R U Y 2 0 1 8
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