3095: You don’t actually need that pupil ring
Managing a moderately small pupil without inserting pupil expansion rings or iris hooks relies on surgical efficiency, deliberate visualization strategies, and gentle tissue manipulation. Utilizing viscoelastic expansion with a high-viscosity or cohesive ophthalmic viscosurgical device often opens the pupil sufficiently to expose the central anterior lens capsule. Performing a precise capsulorhexis under the visible iris margin ensures a continuous opening, providing a secure border for hydrodissection and subsequent phacoemulsification. During nuclear disassembly, keeping all chopping and emulsification maneuvers centered within the pupillary aperture avoids sphincter mechanical trauma while protecting the posterior capsule. Watch the video to see how precise technique and viscoelastic pupil expansion eliminate the need for pupil expansion rings in moderately small pupil cases. What pupil threshold or anatomical feature prompts you to place a mechanical expansion device rather than operating through a smaller aperture? Please comment your thoughts below.
