Single-pass four-throw pupilloplasty: Postoperative mydriasis and fundus visibility in pseudophakic eyes

PURPOSE: To analyze the pharmacological mydriasis and the consequent fundus visibility after single-pass 4-throw pupilloplasty in pseudophakic eyes. SETTING: Dr. Agarwal's Eye Hospital, Chennai, India. DESIGN: Comparative case series. METHODS: Patients with bilateral pseudophakia with single-pass 4-throw pupilloplasty in 1 eye (study) and no single-pass 4-throw in the fellow eye (control) were included. The pupil measurements were analyzed before and after the instillation of mydriatics (tropicamide 0.8%-phenylephrine 5.0% and atropine 1.0%). The dimensions at the baseline and 40, 90, and 120 minutes after instillation were quantified by anterior-segment optical coherence tomography (Visante), a corneal topographer (Orbscan 11z), and an autorefractometer (HRK-7000). The serial photograph (DC3 digital camera) and the fundus imaging (TRC.50DX) were recorded. Changes in pupil size, area, and fundus visibility (50 degrees); the difference in mydriasis between the drugs; and a comparison of mydriasis with the fellow eyes were recorded. RESULTS: The study comprised 22 patients (22 study eyes and 22 control eyes). There was a significant increase in pupil size and area over time (P < .0001). The occurrence of mydriasis was higher in the vertical axis (mean 4.5 mm ± 1.3 [SD]) than in the horizontal axis (mean 4.0 ± 1.3 mm) with a significant difference (P = .021). There was a statistically significant difference in pupil dilation between the study eyes and the control eyes (P = .002). The fundus imaging showed good illumination in 13 eyes (59%) and defective illumination in 9 eyes (41%) for retinal visibility. CONCLUSION: Although pharmacological pupil mydriasis was not equivalent to normal eyes, significant mydriasis occurred and aided in fundus visualization after single-pass 4-throw pupilloplasty.