We recently featured a similar case here where a resident surgeon perform’s the first pupil expansion ring of the career. The goal is not to compare this case to the previous one done by a different resident, but rather to learn the little pearls that make surgery easier and safer. When you first look at this case, you may not think that a pupil ring is needed since the dilation was about 5 mm. But perhaps this patient has floppy iris syndrome from tamsulosin use and the resident is being pro-active. Also it helps to learn these techniques on more routine cases before the very challenging case presents. What advice do you have to offer this young surgeon? Please comment below.
Looks like IFIS, and better to start with Malyugin or other tools to stabilize pupil, than try to play catch up later. Didn’t see when the subincisional iris was damaged, but suggestive of prolapse. Noted stromal defect with bleeding in the last seconds. Use subincisional dispersive viscoelastic to prevent iris prolapse.