This is a really fun cataract surgery. After tens of thousands of cases, an unusual or challenging clinical situation really makes the surgery enjoyable. In this case, the patient has a history of Flomax (tamsulosin) use which is causing floppy iris syndrome and poor pupillary dilation. The case starts out with a reasonable pupil of 4 mm which is then expanded with visco-mydriasis to about 4.5 mm. The capsulorhexis is made larger than the pupil, under the iris, and then phaco chop is performed.
And then the pupil starts to constrict. Miosis is inevitable. What now? Place a pupil expansion ring? For me, a better and easier option is to simply use the chopper to lift the iris in various quadrants in order to get exposure.
Watch the video below to watch this small pupil adventure:
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