This sign means I need a pupil ring

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:


  1. I have 2 new cataract lens -left and right eyes (dual focus and trifocal) (2019);
    definitely have night time driving problems from glare, halos, spider webs from oncoming headlights, street lamps, etc. (LED headlights are the worst!)

    Might you have any recommendations about tinted glasses for low light driving – polarized lenses?
    helpful tinted shades – yellow?

    How safe is it to change cataract lenses? How often is this done?
    Percent of eye casualties???

    Can you please do a column on patient issues?

    1. CataractCoach is for teaching cataract surgery to eye surgeons. It is not intended for non-ophthalmologists.
      If you are having trouble with your cataract surgery results then you need to talk with the eye surgeon who did your surgeries!

Leave a Reply