Our talented guest surgeon does a great job of cataract surgery in a patient with small pupils without using a pupil expansion device such as a Malyugin ring or iris hooks. If you think that you need to use a pupil expansion ring or iris hooks in your cataract surgery, then my advice is to do so without hesitation. Trust your gut instincts and do what is best in your hands and safest for the patient. You may be surprised to know that many experienced cataract surgeons don’t find the need for these devices for the vast majority of small pupil cases. We can do pupil stretching or my preferred technique which is tilting the nucleus out of the bag and having the iris hold it while I chop it. If you have done a few thousand cataract surgeries, ask yourself if you could gravitate towards these techniques and rely less on pupil expansion rings.
