For patients with smaller pupils, such as this case with about a 4 mm pupil diameter, I tend not to use iris hooks or pupil expansion rings. For an experienced surgeon, you can easily and safely remove this cataract and implant the IOL without the need for these devices. When doing these cases, it is helpful to do one final check at the end of the case: after the IOL is implanted and the eye is still full of viscoelastic, use the chopper to lift up the iris and check all around. You can make sure that the IOL is completely within the capsular bag and there is good overlap of the optic by the capsulorhexis, and you can ensure that there is no residual lens cortex hiding in the capsular bag. This video shows the technique and it’s a complete cataract case shown start to finish.
