A 2.75 mm angled 45°, bevel up Short-Head Slit Knife (MANI Inc., Utsunomiya, Japan) was used to create a 2.75-mm self-sealing clear corneal incision at 180º (temporal) and about 1 mm anterior to the limbus. All implanted lenses were trifocal FineVision (PhysIOL, Liege, Belgium), 26% hydrophilic acrylic with double C-loop haptics. An over 30-year experienced surgeon (F.C.) operated on all the patients included in the study sample. This prospective single-center study included a total of 218 eyes from 109 patients with incipient to moderate cataract who underwent bilateral cataract surgery at Clínica Oftalmológica TACIR, Barcelona, Spain.
We have also studied the correlation of pupillary changes with the ACD and with age. The novelty of this study is to describe the behavior of the pupils in two different populations (female and male patients that underwent cataract surgery) by evaluating the pre- and postoperative pupils in two different lighting conditions (photopic and mesopic). 3 However, to the best of our knowledge, they have not considered yet a possible gender-related influence. So far, the published literature concerning the behavior of the pupil after cataract surgery have analyzed the pupil with various instruments and different lighting conditions and explored possible correlations with variables such as age and ACD. Furthermore, we have observed that the reduction in the diameter of the postoperative pupils depends on the patient’s gender. 3 Our clinical experience leads us to conceive the hypothesis that the reduction of pupillary diameters after cataract surgery does not affect the pupils to the same extent in either mesopic or photopic lighting conditions. Previous studies have shown that these changes in the pupillary diameter could be related to the increase of the anterior chamber (ACD) depth postoperatively and be more significant with the increase in the patient's age. 10 determined that, after surgery, pupils suffer from a relative reduction of −9.8% in photopic and −9.1% in mesopic conditions. 7, 8 Besides, they present a loss of contrast sensitivity (SC) at high frequencies. Patients with a large mesopic pupil are more prone to major dysphotopsia problems, affecting more than 42% of patients. 4 This postoperative reduction will mitigate the effects of high-order aberrations such as spherical aberration 5, 6 but on the other hand, it can also limit in practice the benefits of multifocal IOL implants with apodized design. 1, 2, 3 In patients undergoing cataract surgery, the quality of the retinal image will depend not only on the physical characteristics of the implanted IOL but also on their pupillary diameter.
Cataract surgery with an intraocular lens (IOL) implant causes a decrease in pupillary diameters and alterations in both their shape and dynamics.
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