Iris hooks are a reliable method for mechanically expanding a small pupil during cataract surgery, especially when pharmacologic dilation is inadequate. Four to five flexible nylon hooks are inserted through limbal paracenteses and used to retract the iris in a square or diamond configuration, providing a stable and well-centered dilation throughout the procedure.
In cases where the pupil margin has fibrotic tissue or a membrane, careful removal is helpful to restore pupil mobility and allow safe access to the lens. After pupil expansion, viscodissection with a cohesive ophthalmic viscosurgical device can help separate the fibrotic membrane from the iris surface. Micro-forceps or a blunt spatula can then be used to gently peel the membrane, taking care not to damage the iris sphincter. Removing this fibrotic tissue improves visualization, reduces intraoperative complications, and often restores a more functional and cosmetically acceptable pupil postoperatively. Patience and delicate technique are essential.
