Bleeding from Pupil Expander! Now What?

Pupil expansion devices can be helpful to provide sufficient dilation in cataract surgery. This video features guest surgeon Ravi D. Goel, MD from New Jersey, USA showing his technique for Malyugin Ring insertion. In this case, there is a mild complication: bleeding from the iris, which Dr. Goel expertly manages and then completes the case successfully without further issues.

Why does the iris occasionally bleed with insertion of a pupil expansion device or with pupil stretching? Both of these techniques can cause micro-tears in the iris sphincter and can also break small iris blood vessels. This is typically not much of an issue and the bleeding stops relatively easily.

You may be surprised to find out that the amount of iris stretching is the same in these three techniques:

pupil expansion ring implantation
iris hook placement
pupil stretching

pupil circumference — The circumference of the pupil opening is about the same whether we do pupil stretching, use iris hooks, or implant a 7mm pupil expansion ring.

All three of these techniques will give the same expansion to the circumference of the pupil, though the hooks and rings will keep the iris dilated while the pupil stretch technique is a temporary measure during surgery.

So remember that pupil stretching is no more traumatic to the iris tissue than using iris hooks or a pupil expansion ring,