EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/357599
EW CATARACT 20 by Michelle Dalton EyeWorld Contributing Writer pupil," said Kevin M. Miller, MD, Kolokotrones professor of clini- cal ophthalmology, UCLA Stein Eye Institute, Los Angeles. "But for situations where there's fibrotic bands, the pupil stretch works well." Dr. Miller finds it necessary to use a pupil expander in about 1 out of every 10 IFIS cases he performs. Technology advances in both instruments and devices resulted in a "tremendous change in the size of the pupil needed to perform cataract surgery today," said Todd Fladen, MD, founder of The Fladen Eye Center, Canton, Ohio. Iris hooks "are quite useful, and many people still use them," said Boris Malyugin, MD, professor of ophthalmology and deputy director general, S. Fyodorov Eye Microsurgery Institution, Moscow, fibrosis due to other conditions, uveitis, posterior synechiae, or trauma; sometimes the patient's iris shows no sign of an unusual condi- tion, but it does not dilate. Some cataract surgeons may prefer stretching the pupil, using multiple dilating drops, using epinephrine (phenylephrine tends to be preferred in Europe), or using viscosurgical devices (OVDs) to produce viscomydriasis. Those tech- niques are usually enough to get a pupil up to 2 mm to 3 mm, and in some cases may even enlarge it to 4 mm. But in cases where the pupil is not expanding, most will turn to hooks and expanders to make cataract surgery a bit less difficult. "The last thing you'd want to do if there's intraoperative floppy iris syndrome (IFIS) is stretch the T here is no one singular cause for small pupils— they can be caused by medication use (i.e., pilocarpine, tamsulosin), Pupil expanders can help to reduce potential problems surgeons face when patients have small pupils Hooks and expanders ease difficult cataract surgery August 2014 Device focus continued on page 22 This eye, which had a small pupil even after the instillation of mydriatic drops, underwent cataract extraction with toric intraocular lens implantation. Insertion of a 6.25 mm Malyugin ring greatly facilitated the view during surgery. Source (all): Kevin M. Miller, MD Putting quality, precision products into clinics and hospitals worldwide for over 30 years. www.tecfenmedical.com PRECISION OPHTHALMIC PRODUCTS Visit us at ESCRS London – Booth B17