ABSTRACT
Mechanical dilation of pupils is much more sophisticated than it was in the early days of vitreous surgery, when the vitreous cutter was frequently used aggressively to remove substantial amounts of central iris tissue. The simplest method for attempting to enhance pupillary dilation for vitreous surgery is the standard injection of 0.3 ml of 1 : 10 000 epinephrine into the anterior chamber. Diabetic pupillary abnormality often presents as a sympathetic dysfunction resulting in small pupils, light reflex disorders, and difficulty with dilation with standard mydriatics. Time-honored cataract surgical techniques for pupillary enlargement have been abandoned by most modern vitreo-retinal surgeons. The concept of a translimbal approach to mechanical pupillary dilation was a definite advancement, but the suture technique proved cumbersome and has become obsolete. Translimbal mechanical pupillary dilation is achieved quite simply by inserting flexible hooks through 25-gauge needle perforations. Cataract surgeons continue to employ their own evolving means of mechanical pupillary dilation.
