While I don’t use them often, pupil expansion devices such as the Malyugin ring, are useful when performing cataract surgery in eyes with miotic pupils. We want to implant these devices as gently and atraumatically as possible to avoid doing damage to the iris. Too much iris manipulation can also lead to increased levels of post-op inflammation and a longer recovery.
There are a few tips and tricks which can make placement of a pupil expansion ring easier.
- use viscoelastic to tent up the iris in the four spots where the scrolls or coils of the ring will engage the iris. These dollops of viscoelastic will lift the iris above the anterior lens capsule and facilitate ring placement. In the case presented here, we are able to engage three of the four scrolls with the iris edge using just the inserter device alone.
- After all four scrolls are placed, center the ring in the eye using any instrument. Just after ring placement, the pupil center may be displaced, but the ring can be easily shifted and the pupil centered again.
- To remove the device, unhook all four scrolls then simply use the original injector to catch the ring at any point and then retract it into the shaft. The ring may become bent or twisted, but since this is a single-use device, we will discard it anyway.
Watch the video below to learn these tips and tricks for pupil expansion rings:
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