Our guest surgeon is highly talented and from watching this surgery, I suspect has done many thousands of cataract surgeries. The surgery is performed through a small pupil without using a pupil expansion device and it goes well. The question is what is your comfort level? In this case, I would try to stretch and expand the pupil more prior to starting phaco and I would even consider using a pupil ring or iris hooks. And remember that I rarely use these devices since I am happy to operate through a 4 mm or so pupil.
click to learn how this surgeon operates through a small pupil:
This should come with a warning “Don’t try this at home”! Excellent performance by dr.T but a recipe for disaster for most of us!
I remember seeing Dr. Howard Gimbel doing a similar surgery 30 some years ago and I tried it myself with disastrous results I have since learned expand that pupil and make it as easy as possible on myself.