Hypromeliose can be used as a viscoelastic substance during cataract surgery. Two-groups of patients, one group operated on using hypromeliose, the other using sodium hyaluronate as a viscoelastic substance were followed up 2-6 months postoperatively. A total of 16.7% of the eyes operated on using hypromeliose developed a non-reactive semidilated pupil whereas none ofthe eyes from the control group developed this phenomenon. However, it has been noted in our practice that some pupils of eyes operated on with hypromellose 2% used as the viscoelastic substance developed abnormalities in pupil reaction; a number of patients developed a fixed, semi-dilated pupil postoperatively (Figs 1 and 2) resulting in glare, poor quality of vision, as well as cosmetic embarrassment. We have since stopped using hypromellose as a result of these complications. This paper presents a retrospective study comparing the incidence of pupil abnormality in eyes operated on using hypromellose as viscoelastic with a consecutive batch of similar operations performed prospectively by the same surgeon (RCH) using sodium hyaluronate (Healon).Although to our knowledge, there has been no report on the effect of intraocular use of hypromellose on pupil mobility in the ophthalmic literature to date, we were so concerned by our clinical findings that we did not consider it ethical to perform a prospective study using hypromellose.
Subjects and methodsFigure I Non-reactive, semidilated pupil in one ofthe eyes operated on using hypromellose 2% as viscoelastic.