This patient has a small pupil and cataract surgery will be more challenging in this case. We can use a step-wise approach to enlarge the pupil: start with pharmacologic agents like phenylephrine or epinephrine, then perhaps consider pupil stretching along with Osher’s visco-mydriasis, and if needed move to iris hooks or pupil expansion rings. In this video our guest surgeon (anonymous since the video was sent to me unlabeled!) gives the pharmacologic agents and then is able to proceed with surgery. It is a great effort since the 9 mm wide cataract is being removed through a 3.5 to 4 mm diameter pupil. Would you do the same? What would be your approach?
Better use iris hooks, less iris manipulation and more secure surgery