When you have a patient with a small pupil, keep in mind that the iris tissue is very delicate and that the diameter of the cataractous lens is 9 to 10 mm. So if you have a 3 mm pupil, it is quite a challenge to remove the entire cataract through that small opening. Using devices such as iris hooks to expand the pupil can make the surgery far easier, but it does require extra effort. The question is: Is it really needed? Well, it depends on the situation and the surgeon’s level of comfort. If you are earlier in your learning path and want to err on the side of extra safety, then by all means, use the iris hooks. If you find yourself mid-career with tens of thousands of cases of experience, you may not need to use iris hooks and will find yourself asking for them less than 1% of the time. This video goes over some of the basics of iris hooks and our guest surgeon does a great job with demonstrating these pearls. How often do you use iris hooks? Please comment below.
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I prefer to use the Malyugin ring. I have had tears near the periphery of the anterior capsule, with the tip of the iris hooks, during insertion, which, though not occurring frequently, was sufficiently discouraging, to want to continue using them.