EW CATARACT
85
March 2015
5. Using the manipulator, move the
proximal scroll toward the center
of the pupil.
6. Place more OVD around the proxi-
mal scroll to allow the platform of
the inserter to get under the scroll.
7. Engage the proximal scroll with
the control tab and retract it into
the inserter.
8. Using a second instrument,
depress the left and right scrolls
slightly to usher them into the
inserter.
9. Pull the distal scroll into the
inserter completely and then
remove the device.
10.Complete the rest of the cataract
procedure.
Ophthalmologists may find the
video explanation of the modified
Malyugin ring inserter useful. It
shows the Osher modification in use
inserting and removing the Malyu-
gin ring during a cataract procedure.
The Malyugin ring has im-
proved the safety of cataract surgery,
especially in patients with small pu-
pils and particularly those at risk for
intraoperative floppy iris syndrome
(IFIS). The Osher modification of the
inserter allows the surgeon to use
the ring by facilitating engagement
and disengagement of the proxi-
mal scroll. In addition, the design
decreases vertical movement of the
inserter and ring, which further re-
duces the risk of coming in contact
with the corneal endothelium. This
improves surgeon efficiency and
enhances patient safety. EW
References
1. Friedman NJ. Pearls for cataract surgery in
patients with small pupils. OphthalmologyWeb.
March 27, 2012, www.ophthalmologyweb.
com/Featured-Articles/39229-Pearls-for-Cat-
aract-Surgery-in-Patients-With-Small-Pupils/.
Retrieved July 22, 2014.
2. Boughton B. New pupil expansion ring for
floppy iris. EyeNet. January 2008. www.aao.
org/publications/eyenet/200801/cataract.cfm.
Retrieved July 22, 2014.
3. Jacob S. The Malyugin ring. EuroTimes.
18(4):34.
4. Osher, R. Updated Malyugin Ring Inserter
[Video]. Vimeo. bit.ly/18QCSg1. Published April
25, 2014. Accessed July 21, 2014.
Editors' note: Dr. Osher is professor
of ophthalmology at the University of
Cincinnati College of Medicine and
medical director emeritus of Cincinnati
Eye Institute. He has financial interests
with MST.
Contact information
Osher: robert.osher@uc.edu
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