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2728: Malyugin rings can be traumatic

Close-up image of an eye with a Malyugin ring, showing the ring pushing the iris into an angle. Text overlay notes the potential for significant iris damage despite careful handling.

The Malyugin ring is an effective tool for pupil expansion during cataract surgery, but its use can sometimes lead to iris damage. If inserted without proper control or placed asymmetrically, the ring may overstretch the iris or cause focal tearing. This risk increases in eyes with atrophic or floppy iris tissue, such as in pseudoexfoliation or in patients taking tamsulosin. During removal, failing to fully disengage the ring from the pupillary margin before pulling it out can result in iris entrapment, leading to bleeding, sphincter tears, or iridodialysis. Overuse of manipulation or prolonged retention of the device can also lead to postoperative mydriasis or pupil distortion. To minimize complications, the ring should be inserted and removed gently under adequate viscoelastic protection, with attention to even engagement of the iris. When used correctly, it is a safe and valuable aid, but even with careful handling there are cases where it may damage the iris.

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