Iris hooks are very useful for expanding the pupil during cataract surgery. The iris hooks have an advantage over pupil rings in that their effect is customizable, titratable, and does not add bulk into a shallow anterior chamber. There are many important tips and tricks that will facilitate your use of iris hooks. When making the incisions, you only need to make them as wide as the hooks which means smaller than a typical paracentesis. These incisions can also be made closer to the limbus and then angled so that the hooks are pointed right at the iris plane. A small amount of viscoelastic can be placed under the iris edge to facilitate hooking the pupil margin. Hooks can be placed in a square configuration (like this case) or shifted 45 degrees to make a diamond shape. This places one hook under the main incision and helps to pull the iris away from the sub-incisional space to avoid iatrogenic damage. While four hooks are usually used, most sets include 5 hooks so that a pentagon configuration can be employed. Once all hooks are placed then go back and tighten them individually to titrate to the desire pupil opening. To remove the hooks, carefully unhook the iris and remove them gently. While you can simply just tug or yank them out, that would be a bit less than elegant, right?
