In my private practice many patients have light colored irides with scant pigmentation. The iris stroma tends to be very delicate and not as sturdy as a darkly pigmented iris. This patient has essentially no pigment and the iris appears pale blue. The prior episode of anterior uveitis left a large area of posterior synechaie which resulted in a small pupil. In a case like this the iris tissue will be very fragile and excessive manipulation can lead to iatrogenic damage and a disfigured pupil. With a dark brown iris, defects are not very noticeable from conversation distance, but with this pale blue iris, any iris damage will create a visible cosmetic deformity. A novice surgeon would likely opt for a pupil expansion ring or perhaps iris hooks to complete the case. And that can work but the risk of iris damage is high, particularly with a pupil expansion ring since that cannot be titrated the way that iris hooks can. I chose to perform this surgery without these devices and this video shows you my preferred technique.
