Materials and Methods: Fourty-six eyes of 41 patients who had small pupils and underwent phacoemulsification surgery with flexible iris retractor hooks between March 2001 and June 2005 were evaluated retrospectively. Main outcome measures were causitive factors for small pupils, pupil sizes before surgery, while hooks were in place, after the hooks were removed and during the postoperative period. Complications, pupillary light response and pupil shape at postoperative period were also evaluated.

Results: Mean age was 69.6±5.25 years, mean follow-up time was 14.87±4.63 months. Small pupils were caused by pseudoexfoliation in 21 eyes (46%), uveitis in 19 eyes (41%), previous pars plana vitrectomy surgery in 4 eyes (9%), primary angle-closure glaucoma and long-term pilocarpine therapy in 2 eyes (4%). Mean pupillary diameter at the beginning of surgery, before iris hooks were inserted was 3.5±0.3 mm, after the pupil hooks were inserted and after the hooks were removed were 6.2±0.3 mm and 5.8±0.7 mm, respectively. Visual acuity levels were improved in all eyes postoperatively. All the pupils were round during the postoperative follow-up and pupillary light response was not affected in any of the eyes.

Conclusion: Flexible iris retractor hooks are useful tools in cataract surgery with small pupil which help reduce the complication rate but do not alter the pupillary function. Keywords : Small pupil, cataract, iris retractor hook, phacoemulsification