{"id":11397,"date":"2020-06-28T02:52:02","date_gmt":"2020-06-27T23:52:02","guid":{"rendered":"https:\/\/drborismalyugin.com\/operatsiya\/complicated-cataract-surgery\/pri-nedostatochnom-midriaze"},"modified":"2020-08-16T23:12:08","modified_gmt":"2020-08-16T20:12:08","slug":"small-pupil-cases","status":"publish","type":"operatsiya","link":"https:\/\/drborismalyugin.com\/en\/operatsiya\/complicated-cataract-surgery\/small-pupil-cases","title":{"rendered":"Small pupil cases"},"content":{"rendered":"<section class=\"l-section wpb_row height_custom\"><div class=\"l-section-h i-cf\"><div class=\"g-cols vc_row via_flex valign_top type_default stacking_default\"><div class=\"vc_col-sm-12 wpb_column vc_column_container\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><div class=\"wpb_text_column\"><div class=\"wpb_wrapper\"><p>Normally, the pupil reacts actively to variable lighting conditions. In good lighting, it is narrow, becoming wider in the evening and at night. Some pharmacological substances cause the pupil to expand, facilitating examination of the eye or eye surgery. In a significant number of patients, due to co-morbidities or the use of medications, insufficient pupil expansion (mydriasis) is present. This problem greatly complicates cataract removal, and is often accompanied by several other negative factors (weakness of the lens zonules, blood-ocular barrier disruption, increased risk or ocular inflammation, etc.).<\/p>\n<\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/section><section class=\"l-section wpb_row height_custom color_alternate\"><div class=\"l-section-h i-cf\"><div class=\"g-cols vc_row via_flex valign_top type_default stacking_default\"><div class=\"vc_col-sm-12 wpb_column vc_column_container\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><div class=\"w-iconbox us_custom_70facfb4 iconpos_left style_default color_secondary align_left no_text\"><div class=\"w-iconbox-icon\" style=\"font-size:3rem;\"><i class=\"fad fa-eye\"><\/i><\/div><div class=\"w-iconbox-meta\"><h2 class=\"w-iconbox-title\" style=\"font-size:1.2rem;\">The predominant causes of insufficient mydriasis include:<\/h2><\/div><\/div><div class=\"wpb_text_column\"><div class=\"wpb_wrapper\"><ul>\n<li>Glaucoma.<\/li>\n<li>Pseudoexfoliation syndrome.<\/li>\n<li>Previous eye inflammation (uveitis, iridocyclitis, eye surgery, etc.).<\/li>\n<li>Age-related atrophy of the iris.<\/li>\n<li>Intake of medications (for the treatment of benign prostate hyperplasia, systemic hypertension, psychosis, etc.).<\/li>\n<li>Diabetes.<\/li>\n<\/ul>\n<\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/section><section class=\"l-section wpb_row height_custom\"><div class=\"l-section-h i-cf\"><div class=\"g-cols vc_row via_flex valign_top type_default stacking_default\"><div class=\"vc_col-sm-12 wpb_column vc_column_container\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><div class=\"w-iconbox us_custom_70facfb4 iconpos_left style_default color_secondary align_left no_text\"><div class=\"w-iconbox-icon\" style=\"font-size:3rem;\"><i class=\"fad fa-eye\"><\/i><\/div><div class=\"w-iconbox-meta\"><h2 class=\"w-iconbox-title\" style=\"font-size:1.2rem;\">Consequences for cataract removal in small pupil cases<\/h2><\/div><\/div><div class=\"wpb_text_column\"><div class=\"wpb_wrapper\"><p>Small pupil is not a &#8220;dead-end&#8221; for cataract removal. The modern ophthalmologist has a number of effective methods for addressing this challenge. At the same time, it is important to understand that cataract surgery in the case of small pupil is associated with the risks of lens capsule rupture, iris trauma, vitreous loss, and significant inflammation.<\/p>\n<\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/section><section class=\"l-section wpb_row height_auto width_full\"><div class=\"l-section-h i-cf\"><div class=\"g-cols vc_row via_flex valign_top type_default stacking_default\"><div class=\"vc_col-sm-12 wpb_column vc_column_container\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><section class=\"l-section wpb_row us_custom_938809ae height_auto color_primary\"><div class=\"l-section-h i-cf\"><div class=\"g-cols vc_row via_flex valign_middle type_default reversed stacking_default\"><div class=\"vc_col-sm-6 wpb_column vc_column_container\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><div class=\"w-image us_custom_1fd2f432 style_shadow-1 align_center\"><div class=\"w-image-h\"><img decoding=\"async\" width=\"358\" height=\"512\" src=\"https:\/\/drborismalyugin.com\/wp-content\/uploads\/malyugin-3-358x512.jpg\" class=\"attachment-medium size-medium\" alt=\"\" loading=\"lazy\" srcset=\"https:\/\/drborismalyugin.com\/wp-content\/uploads\/malyugin-3-358x512.jpg 358w, https:\/\/drborismalyugin.com\/wp-content\/uploads\/malyugin-3.jpg 601w\" sizes=\"auto, (max-width: 358px) 100vw, 358px\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"vc_col-sm-6 wpb_column vc_column_container has_bg_color stretched\"><div class=\"vc_column-inner us_custom_df02dd93\"><div class=\"wpb_wrapper\"><div class=\"w-iconbox us_custom_70facfb4 iconpos_left style_default color_contrast align_center no_text\"><a href=\"tel:+74999065001\" class=\"w-iconbox-link\" aria-label=\"+7 (499) 906-50-01\"><div class=\"w-iconbox-icon\" style=\"font-size:2rem;\"><i class=\"fal fa-phone-alt\"><\/i><\/div><\/a><div class=\"w-iconbox-meta\"><h2 class=\"w-iconbox-title\"><a href=\"tel:+74999065001\" class=\"w-iconbox-link\" aria-label=\"+7 (499) 906-50-01\">+7 (499) 906-50-01<\/a><\/h2><\/div><\/div><div class=\"wpb_text_column\"><div class=\"wpb_wrapper\"><p style=\"text-align: center;\">You can make an appointment by phone from 8:30 to 19:30 (daily).<\/p>\n<\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/section>\n<\/div><\/div><\/div><\/div><\/div><\/section><section class=\"l-section wpb_row height_custom\"><div class=\"l-section-h i-cf\"><div class=\"g-cols vc_row via_flex valign_top type_default stacking_default\"><div class=\"vc_col-sm-12 wpb_column vc_column_container\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><div class=\"w-iconbox us_custom_70facfb4 iconpos_left style_default color_secondary align_left no_text\"><div class=\"w-iconbox-icon\" style=\"font-size:3rem;\"><i class=\"fad fa-eye\"><\/i><\/div><div class=\"w-iconbox-meta\"><h2 class=\"w-iconbox-title\" style=\"font-size:1.2rem;\">Cataract removal in insufficient mydriasis<\/h2><\/div><\/div><div class=\"wpb_text_column\"><div class=\"wpb_wrapper\"><p>A small, poorly dilated pupil simply cannot provide enough space for the surgeon to work. Access to the lens is very limited and the surgeon\u2019s effectiveness is greatly constrained. To avoid undesirable consequences during and after the surgical procedure, a number of special technological advances have been developed.<\/p>\n<p>The surgical armamentarium includes use of special phaco machine settings, use of proper viscoelastic with a higher viscosity, dissection of the adhesions between the lens and pupil, and other techniques. In relatively mild cases, intraocular injection of a mydriatic drug turns out to be very useful and quite sufficient. In other cases, a gentle stretching of the pupil with microsurgical instruments is needed. Most frequently, mechanical and pharmacological methods are combined.<\/p>\n<p>The Malyugin ring is a pupil-expander device popular among surgeons across the world.<\/p>\n<\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/section><section class=\"l-section wpb_row height_custom color_alternate\"><div class=\"l-section-h i-cf\"><div class=\"g-cols vc_row via_flex valign_top type_default stacking_default\"><div class=\"vc_col-sm-12 wpb_column vc_column_container\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><div class=\"w-iconbox us_custom_70facfb4 iconpos_left style_default color_secondary align_left no_text\"><div class=\"w-iconbox-icon\" style=\"font-size:3rem;\"><i class=\"fad fa-eye\"><\/i><\/div><div class=\"w-iconbox-meta\"><h3 class=\"w-iconbox-title\" style=\"font-size:1.2rem;\">When is cataract surgery recommended?<\/h3><\/div><\/div><div class=\"wpb_text_column\"><div class=\"wpb_wrapper\"><ul>\n<li>Vision is decreased by 50% or more.<\/li>\n<li>Unwanted optical phenomena and decreased contrast sensitivity are causing discomfort and interfere with regular activities at home or at work.<\/li>\n<li>Changes in visual perception are decreasing quality of life.<\/li>\n<li>The patient sees halos around light sources.<\/li>\n<li>The disease has reached an advanced stage.<\/li>\n<\/ul>\n<\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/section><section class=\"l-section wpb_row height_custom\"><div class=\"l-section-h i-cf\"><div class=\"g-cols vc_row via_flex valign_top type_default stacking_default\"><div class=\"vc_col-sm-12 wpb_column vc_column_container\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><div class=\"w-message color_red with_icon\"><div class=\"w-message-icon\"><i class=\"fas fa-engine-warning\"><\/i><\/div><div class=\"w-message-body\"><p>Contraindications:<\/p>\n<p>Lack of prospects for improving functional vision (as a result of eye co-morbidity such as optic nerve atrophy, retinal detachment, or degeneration), acute eye inflammation, decompensated systemic co-morbidities (diabetes, systemic hypertension, rheumatoid arthritis, etc.), history of stroke or heart attack (within 6 months before the surgical procedure).<\/p>\n<\/div><\/div><div class=\"wpb_text_column\"><div class=\"wpb_wrapper\"><p>Ophthalmic surgeons share experiences and new methods for conducting complicated surgery at international congresses yearly. Science does not stand still; surgical procedures are becoming safer and more effective. New methods and surgical tools are continually being developed and appearing in the doctor\u2019s toolkit, aimed at providing immediate assistance in difficult cases.<\/p>\n<\/div><\/div><div class=\"g-cols wpb_row via_flex valign_top type_default stacking_default\"><div class=\"vc_col-sm-6 wpb_column vc_column_container\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><div class=\"w-image align_center meta_modern\"><a ref=\"magnificPopup\" href=\"https:\/\/drborismalyugin.com\/wp-content\/uploads\/professor-malyugin-preparing-for-live-surgery-session-at-the-new-york-eye-and-ear-infirmary-usa.jpg\" aria-label=\"Professor Malyugin preparing for live surgery session at the New York Eye and Ear Infirmary (USA)\" class=\"w-image-h\"><img decoding=\"async\" width=\"512\" height=\"384\" src=\"https:\/\/drborismalyugin.com\/wp-content\/uploads\/professor-malyugin-preparing-for-live-surgery-session-at-the-new-york-eye-and-ear-infirmary-usa-512x384.jpg\" class=\"attachment-medium size-medium\" alt=\"\" loading=\"lazy\" srcset=\"https:\/\/drborismalyugin.com\/wp-content\/uploads\/professor-malyugin-preparing-for-live-surgery-session-at-the-new-york-eye-and-ear-infirmary-usa-512x384.jpg 512w, https:\/\/drborismalyugin.com\/wp-content\/uploads\/professor-malyugin-preparing-for-live-surgery-session-at-the-new-york-eye-and-ear-infirmary-usa-600x450.jpg 600w, https:\/\/drborismalyugin.com\/wp-content\/uploads\/professor-malyugin-preparing-for-live-surgery-session-at-the-new-york-eye-and-ear-infirmary-usa.jpg 800w\" sizes=\"auto, (max-width: 512px) 100vw, 512px\" \/><div class=\"w-image-meta\"><div class=\"w-image-title\">Professor Malyugin preparing for live surgery session at the New York Eye and Ear Infirmary (USA)<\/div><\/div><\/a><\/div><\/div><\/div><\/div><div class=\"vc_col-sm-6 wpb_column vc_column_container\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><div class=\"w-image align_center meta_modern\"><a ref=\"magnificPopup\" href=\"https:\/\/drborismalyugin.com\/wp-content\/uploads\/professor-malyugin-performing-live-surgery-in-krakow-poland.jpg\" aria-label=\"Professor Malyugin performing live surgery in Krakow (Poland)\" class=\"w-image-h\"><img decoding=\"async\" width=\"512\" height=\"384\" src=\"https:\/\/drborismalyugin.com\/wp-content\/uploads\/professor-malyugin-performing-live-surgery-in-krakow-poland-512x384.jpg\" class=\"attachment-medium size-medium\" alt=\"\" loading=\"lazy\" srcset=\"https:\/\/drborismalyugin.com\/wp-content\/uploads\/professor-malyugin-performing-live-surgery-in-krakow-poland-512x384.jpg 512w, https:\/\/drborismalyugin.com\/wp-content\/uploads\/professor-malyugin-performing-live-surgery-in-krakow-poland-600x450.jpg 600w, https:\/\/drborismalyugin.com\/wp-content\/uploads\/professor-malyugin-performing-live-surgery-in-krakow-poland.jpg 800w\" sizes=\"auto, (max-width: 512px) 100vw, 512px\" \/><div class=\"w-image-meta\"><div class=\"w-image-title\">Professor Malyugin performing live surgery in Krakow (Poland)<\/div><\/div><\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/section>\n","protected":false},"featured_media":11332,"parent":11389,"menu_order":0,"template":"","meta":{"footnotes":""},"categories":[80],"tags":[],"class_list":["post-11397","operatsiya","type-operatsiya","status-publish","has-post-thumbnail","hentry","category-procedures"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/drborismalyugin.com\/en\/wp-json\/wp\/v2\/operatsiya\/11397","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drborismalyugin.com\/en\/wp-json\/wp\/v2\/operatsiya"}],"about":[{"href":"https:\/\/drborismalyugin.com\/en\/wp-json\/wp\/v2\/types\/operatsiya"}],"version-history":[{"count":0,"href":"https:\/\/drborismalyugin.com\/en\/wp-json\/wp\/v2\/operatsiya\/11397\/revisions"}],"up":[{"embeddable":true,"href":"https:\/\/drborismalyugin.com\/en\/wp-json\/wp\/v2\/operatsiya\/11389"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/drborismalyugin.com\/en\/wp-json\/wp\/v2\/media\/11332"}],"wp:attachment":[{"href":"https:\/\/drborismalyugin.com\/en\/wp-json\/wp\/v2\/media?parent=11397"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/drborismalyugin.com\/en\/wp-json\/wp\/v2\/categories?post=11397"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/drborismalyugin.com\/en\/wp-json\/wp\/v2\/tags?post=11397"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}