Comparative early postoperative outcomes of iris hooks, sphincterotomy, and pupil expanders in phacoemulsification for nondilating pupils: A prospective cohort study
Abstract
Background: Cataract surgery in patients with nondilating pupils poses significant intraoperative challenges and increases the risk of complications. Various mechanical pupil expansion techniques, including iris hooks, sphincterotomy, and pupil expanders, are used during phacoemulsification; however, comparative evidence regarding their early postoperative outcomes remains limited. The objective of the study is to compare the early postoperative efficacy and safety of iris hooks, sphincterotomy, and pupil expanders in patients undergoing phacoemulsification for nondilating pupils. Methods: This prospective observational cohort study included 55 patients with cataracts and nondilating pupils who underwent phacoemulsification using iris hooks (n = 20), sphincterotomy (n = 20), or pupil expanders (n = 15). Surgical outcomes, intraoperative complications, postoperative corneal clarity, pupil morphology, iris status, and best-corrected visual acuity were assessed during follow-up visits on day 1, week 1, and week 4. Statistical analysis was performed using appropriate parametric and nonparametric tests, with a significance level set at P < 0.05. Results: Baseline demographic characteristics were comparable across the three groups. Sphincterotomy achieved a 100% surgical success rate with no intraoperative complications, but resulted in permanent pupil irregularity in all cases. Iris hooks and pupil expanders preserved round pupil morphology in 80% and 60% of cases, respectively, but were associated with higher rates of minor intraoperative complications. Postoperative corneal clarity improved progressively in all groups, with complete resolution by week 4. Final visual acuity outcomes at week 4 were comparable among the groups, with no statistically significant difference observed (P > 0.05). Conclusion: All three techniques enable successful phacoemulsification in eyes with nondilating pupils during the early postoperative period. While sphincterotomy provides excellent intraoperative safety, it is associated with permanent pupil irregularity. Iris hooks and pupil expanders better preserve pupil morphology, but may carry a slightly higher risk of intraoperative complications. The choice of technique should be individualized based on intraoperative findings and surgical priorities. The short duration of follow-up is a limitation, and longer-term studies are warranted.
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BibTeX
@article{gayathri2026comparative,
title = {{Comparative early postoperative outcomes of iris hooks, sphincterotomy, and pupil expanders in phacoemulsification for nondilating pupils: A prospective cohort study}},
author = {Donthula Gayathri and Sachin Daigavane},
journal = {Journal of Clinical Sciences},
year = {2026},
month = jul,
doi = {10.4103/jcls.jcls_131_25},
url = {https://doi.org/10.4103/jcls.jcls_131_25},
note = {CC BY-NC-SA},
}
RIS
TY - JOUR
TI - Comparative early postoperative outcomes of iris hooks, sphincterotomy, and pupil expanders in phacoemulsification for nondilating pupils: A prospective cohort study
AU - Donthula Gayathri
AU - Sachin Daigavane
PY - 2026
DA - 2026/07/01
JO - Journal of Clinical Sciences
DO - 10.4103/jcls.jcls_131_25
UR - https://doi.org/10.4103/jcls.jcls_131_25
AB - Background: Cataract surgery in patients with nondilating pupils poses significant intraoperative challenges and increases the risk of complications. Various mechanical pupil expansion techniques, including iris hooks, sphincterotomy, and pupil expanders, are used during phacoemulsification; however, comparative evidence regarding their early postoperative outcomes remains limited. The objective of the study is to compare the early postoperative efficacy and safety of iris hooks, sphincterotomy, and pupil expanders in patients undergoing phacoemulsification for nondilating pupils. Methods: This prospective observational cohort study included 55 patients with cataracts and nondilating pupils who underwent phacoemulsification using iris hooks (n = 20), sphincterotomy (n = 20), or pupil expanders (n = 15). Surgical outcomes, intraoperative complications, postoperative corneal clarity, pupil morphology, iris status, and best-corrected visual acuity were assessed during follow-up visits on day 1, week 1, and week 4. Statistical analysis was performed using appropriate parametric and nonparametric tests, with a significance level set at P < 0.05. Results: Baseline demographic characteristics were comparable across the three groups. Sphincterotomy achieved a 100% surgical success rate with no intraoperative complications, but resulted in permanent pupil irregularity in all cases. Iris hooks and pupil expanders preserved round pupil morphology in 80% and 60% of cases, respectively, but were associated with higher rates of minor intraoperative complications. Postoperative corneal clarity improved progressively in all groups, with complete resolution by week 4. Final visual acuity outcomes at week 4 were comparable among the groups, with no statistically significant difference observed (P > 0.05). Conclusion: All three techniques enable successful phacoemulsification in eyes with nondilating pupils during the early postoperative period. While sphincterotomy provides excellent intraoperative safety, it is associated with permanent pupil irregularity. Iris hooks and pupil expanders better preserve pupil morphology, but may carry a slightly higher risk of intraoperative complications. The choice of technique should be individualized based on intraoperative findings and surgical priorities. The short duration of follow-up is a limitation, and longer-term studies are warranted.
SN - 2468-6859
SN - 2408-7408
ER -