Effect of mydriasis degree on intraoperative complications in patients with complicated cataract associated with pseudoexfoliative syndrome

Relevance. Cataract is one of the causes of blindness and low vision among the pathology of the organ of vision. Medication to cure cataracts is extremely ineffective. According to statistics, over the past year, there are about a million patients diagnosed with cataracts. The main method of surgical treatment of cataracts is phacoemulsification. The main cause of a narrow pupil with lens opacities is pseudoexfoliative syndrome, which affects the development of the disease, both in the intraoperative and postoperative periods. The aim of this study is to evaluate the effect of mydriasis on intraoperative complications in patients with complicated cataract in PES. Materials and Methods. The study involved 176 patients of varying severity of PES and a control group without signs of PES. Patients underwent ophthalmological diagnostics (visometry, biomicroscopy, ophthalmoscopy, CCFM, ruler for measuring pupil diameter, pneumotonometry, IOP according to A.N. Maklakov, 10g weight, OST of the anterior segment). In addition to ophthalmological examinations, all patients underwent anamnesis and laboratory tests before surgery according to generally accepted methods. Preoperative preparation of the patient included both drug therapy and a psychological aspect. Particular importance was attached to premedication. All patients in all study groups were prescribed a sedative (per os) 1 hour before surgery. In all observation groups, in order to achieve the cycloplegia required during the operation, instillations of mydriatics were performed according to the scheme. Results and Discussion. Evaluation of the results revealed that the degree of mydriasis is a statistically significant risk factor for the development of all complications except “conjunctiva”. For the conjunctiva, no statistically significant risk factors were found among the selected parameters. AUC for ROC curves are in the range of 0.7–0.9 for all complications, which indicates a good and satisfactory choice of model parameters. In the “photophobia” regression, the risk of developing complications is 6 higher with mydriasis up to 5 mm in the postoperative period, and 26 times higher to get a complication with mydriasis less than 4 mm. In the regression of “chamber moisture” — the moisture of the anterior and posterior chambers, the risk of developing turbid fluid is 353 times higher with mydriasis less than 4 mm, and 27 times higher with mydriasis up to 5 mm. Conclusion. The characteristic signs of pseudoexfoliation syndrome undoubtedly complicate the surgeon’s work: rigid narrow pupil, ciliary muscle weakness, iridodonesis, phacodonesis. When planning cataract surgery, special attention should be paid to diagnosis, history taking in terms of general somatic features, and the choice of mydriatics. This work showed how much the degree of mydriasis can influence complications in the intraoperative period.