Push and Pull Method for Small Incision Cataract Surgery in Small Pupil: An Innovative Technique

A significant number of patients who present for cataract surgery have pupils that do not respond adequately despite several pharmacological attempts with different mydriatic agents. Most of the current available surgical maneuvers for enlarging the pupil and preventing its intraoperative constriction are not safe enough. They can lead to an increased risk of iris sphincter tear, bleeding, iris damage, posterior capsule tears, and loss of the vitreous body. The postoperative complications can include an atonic pupil of irregular shape leading to poor visual and cosmetic result. Large pupils postoperatively are associated with glare and a reduced depth of focus. We present our innovative technique “Push and pull method “for small incision cataract surgery in small pupils. This push and pull method of pupillary dilatation minimizes the likelihood of iris sphincter tears, thereby leading to no postoperative irregular dilated pupil and glare and better visual outcome.