Managing Challenges of Recalcitrant Intra-Operative Miosis during Small Incision Cataract Surgery

Reviewed current literature on causes and treatment of recalcitrant intraoperative miosis during small incision cataract surgery (SICS). A Medline, PubMed and Cochrane database internet search was conducted with reference manager 11. Google search was done using key words such as small incision cataract surgery and intraoperative miosis. Some pupils are inherently difficult to either dilate or sustain intraoperative mydriasis, e.g. intraoperative floppy iris syndrome (IFIS). Slow penetration through cornea, limited bioavailability and waning effects of routine topical mydriatics (TMs) are some setbacks that could pose daunting intraoperative challenges. Maintenance of sufficient pupillary dilatation during SICS can be important in successful completion of the operation. A poorly dilating pupil should be identified before surgery so that strategies and equipment are available to the SICS surgeon for the patient.