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EW ASCRS•ASOA 2017 64 ASCRS•ASOA Program Preview • May 5–9, 2017 the orientation of the lens and the alignment, Dr. Malyugin said. Additionally, surgeons may choose different strategies for han- dling small pupils depending on their skill levels. Size of the pupil is relative to the surgeon's skills and technique. For experienced sur- geons, small pupils in the range of 4.0–4.5 mm may not be challenging at all in some cases, Dr. Malyugin said, but for beginner surgeons, this could be a big issue. However, the surgeon should be concerned not only with the pupil size, but also with the biomechan- ical properties of the iris tissue. For instance, in IFIS, the pupil might be big enough initially, but then it's constriction, and lack of muscle tone and tissue rigidity gradually makes these cases extremely chal- lenging. Dr. Malyugin also highlighted specific recommendations for small pupils, including adjusting the flu- idic and power machine settings. He also discussed a step by step surgical algorithm to these patients, which involves considering options like intracameral medications, choosing the right viscoelastic, dissecting of synechiae, and selecting the devices to help stretch or expand the pupil mechanically. During his lecture, Dr. Malyugin will also discuss the different pupil expansion devices that surgeons may consider using in these cases, including the Malyugin ring (Mi- croSurgical Technology, Redmond, Washington), which he said many gained awareness of after the 2006 ASCRS Film Festival when he pre- sented and won first prize for a vid- eo on the device in the instruments/ devices category. Dr. Malyugin said his lecture will also highlight the history of that innovation. EW Editors' note: Dr. Malyugin has financial interests with MicroSurgical Technology. Contact information Malyugin: boris.malyugin@gmail.com by Ellen Stodola EyeWorld Senior Staff Writer consider when dealing with small pupils. "I believe that if we're talking in general, the cases with small pupils are about 5% of all the cases that the surgeon is having in his practice," Dr. Malyugin said, adding that this will also vary depending on the patient population because some surgeons may see more glaucoma or pseudoexfoliation patients. When you are dealing with these patients, he said, you have to keep in mind that the concern is not just the size of the pupil but that the size of the pupil is an indicator of the pathology. Small pupils can be general indicators of increased permeability of blood-aqueous bar- rier and inflammation, he said, and there are various other comorbidities that surgeons should look for as well. "These patients are not only technically more challenging, but they are challenging with respect to the results of the surgery and they are challenging with respect to this underlying pathology," he said. In pseudoexfoliation syndrome, for example, small pupils and zonular weakness go hand in hand. Small pupils require preoperative, intraop- erative, and postoperative consider- ations. If the small pupil was the result of inflammation, you can expect the inflammation to be more pro- nounced after surgery. And that is not only in the anterior segment of the eye. We can also expect higher chance for cystoid macular edema, Dr. Malyugin said, so you have to treat these patients a little more aggressively with pharmacological agents in order to prevent and cure all these inflammatory responses. The biggest technical challenge in small pupil cases is that they im- pede the ability of the surgeon to ac- cess the lens, to remove it complete- ly, and to implant the intraocular lens, he said. Here we have a much higher risk of capsular and zonular complications. Also, if you're im- planting a toric lens, you need a big enough pupil. You have to be sure of Dr. Malyugin's Binkhorst Lecture will highlight cataract surgery in small pupils T his year's Binkhorst Lecture will be given by Boris Mal- yugin, MD, PhD, Moscow, Russia. The lecture is titled "Cataract Surgery in Small Pupils: Building the Bridge Over Troubled Waters." Dr. Malyugin is deputy director general (R&D, Education) at the S. Fyodorov Eye Microsurgery Institution (Moscow, Russia) and is president of the Rus- sian Ophthalmology Society. Dr. Malyugin shared with Eye- World details on what his lecture will cover and some important things to April 2017 Boris Malyugin, MD, PhD, to present 2017 Binkhorst Lecture Doyle Stulting, MD, PhD, presented the Binkhorst Lecture at the 2016 ASCRS•ASOA Symposium & Congress in New Orleans. Source: ASCRS Boris Malyugin, MD, PhD

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