This is the background for the rationale for performing “pupil-customized cataract surgery (PCCS).”Īs shown in Fig. Therefore, we may successfully predict the postoperative pupil size, affecting the refractive outcomes and subsequent patient satisfaction after cataract surgery, if we can accurately and reproducibly determine the preoperative pupil size. showed no significant differences in pupil diameter or shift between pseudophakic and cataractous eyes using the NIDEK OPD-Scan, under low mesopic or photopic conditions, suggesting that uncomplicated in-the-bag IOL implantation had no significant adverse effect on pupillary mechanics. Hayashi and Hayashi demonstrated, in a study of 386 eyes undergoing uncomplicated phacoemulsification with IOL implantation, that there was a strong positive correlation between preoperative and postoperative pupil size obtained with the Colvard pupillometer. Accordingly, the postoperative pupil size can be predicted from the preoperative measurements. However, modern cataract surgery using newer phacoemulsification techniques has been reported to induce a transient decrease in pupil size immediately after surgery, probably because of the traumatic release of miotic neuropeptides, but soon recovers to the preoperative levels. It has been demonstrated that the postoperative pupil size cannot be predicted from the preoperative size with sufficient consistency, possibly because the pupil is substantially impaired by previous cataract surgery. In this chapter, we will look at the rationale for the clinical assessment of the preoperative pupil size in order to predict and maximize the postoperative visual performance in cataract surgery. However, it is known that pupil size also plays an important role in the visual outcomes of the surgical procedure.
At present, most cataract surgeons merely consider that it is essential to reduce the possible refractive errors as much as possible for cataract surgery. Since refractive errors can lead to both a decrease in uncorrected visual acuity and deterioration of quality of vision, reducing possible refractive errors and acquiring good visual outcomes are two essentials to the minimization of spectacle dependence and to the maximization of subsequent patient satisfaction.
Modern cataract surgery has some aspects of refractive surgery, because the postoperative refractive errors can be reduced by the introduction of the partial coherence laser interferometry and because the surgically induced astigmatism can be minimized by small-incision cataract surgery. Although cataract surgery has been performed for many centuries, technological advances now provide us with the opportunity to have excellent visual outcomes after this surgery.
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