From watching CataractCoach videos, you know that in almost all small pupil cases, we can do a beautiful cataract surgery by using specialized techniques, without the use of a pupil expansion ring or iris hooks. But there are some cases where using a device to expand the pupil and hold the iris securely are critical for success in the surgery. This is that type of case where the patient has severe intra-operative floppy iris syndrome (IFIS) from use of Flomax (tamsulosin). This is also a small, hyperopic eye with smaller anterior segment.
Iris prolapse to the paracentesis incision is the sign that lets me know immediately that we will need to use a pupil ring. This paracentesis is about 1 mm (or smaller) in width and even still, this allows iris to prolapse and plug the incision. By inserting the pupil expansion ring, we are able to expand the dilation to 6.25 mm while also holding the iris away from our surgical instruments.
Click below to learn how to recognize this critically important sign: