These are my pearls for implanting a toric IOL and achieving accurate alignment in small pupil cataract cases. These cases are tougher since you need to see the toric IOL marks which are at the outer zone of the optic. When you have a 4 mm pupil these toric alignment marks on the 6 mm optic are not visible. Here is how I do it without a pupil ring and without iris hooks.
click to learn how I align the toric IOL in small pupil cases:
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