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recommend using a dilation device (either hooks or rings)
to dilate the pupil in order to perform the capsule opening
and remove the device before prolapsing the nucleus."
Another situation where a surgeon should take
caution with pupillary dilation is in cases of patients with
uveitis.
"In some patients, the iris can become damaged or re-
main dilated if the iris is stretched with a dilation device,"
Dr. Henderson said. "The device may be necessary to
perform the surgery safely so it is still prudent to use one,
but the surgeon should be aware that the pupil may not
constrict back to the same preoperative size."
Dr. Tipperman also has tried multiple devices, but he
prefers the Malyugin ring for dilation due to its ease of
insertion, placement, and removal.
However, Dr. Tipperman avoids the use of the ring
in very small pupils or fibrotic pupils, where it can still
produce sphincter tears.
"Especially if I'm using a multifocal IOL in these
cases, I try to avoid mechanical pupillary dilation," Dr.
Tipperman said.
MAY 2019 | EYEWORLD | 29
Pupil expansion with the Malyugin ring
Source: Uday Devgan, MD
