There are some cases where you absolutely need a pupil expansion ring or iris hooks, such as this case. That case shows the sign of iris prolapse via the initial paracentesis right at the start of the case. When that happens, I just accept that I will need a pupil ring. There is also a sign that tells me that I will not likely need a pupil ring during a cataract surgery: a pupil of about 4-5mm with a round margin and no tendency towards iris prolapse. This video is a complete cataract case where we show the entire surgery, start to finish. And I’ll share with you my pearls for deciding whether or not to use a pupil expansion ring.
click to learn about this sign which tells me that no pupil ring is needed: