September 2017
EW CATARACT
41
very low vacuum. I left the OVD in
the chamber, separated the lens into
two hemispheres, chopped one into
quadrants, and brought each apex
into the middle of the pupil. I used
a bank technique; for the first three
quadrants, I always have a bank of
the adjacent nuclear quadrant next
to where I am working, which holds
the capsule back.
I quickly injected the lens,
placed it in the capsular bag, and
removed the Malyugin Ring. The
Malyugin Ring made this case safer
and easier.
Case #3
This patient also had nanophthal-
mos. The eye was very small with an
axial length measuring only 20 mm.
The patient had also had a periph-
eral iridotomy for angle closure.
In this case, I swept the peribulbar
anesthetic away from the incision,
which had caused the conjunctiva
to balloon forward, allowing me to
make a good three-plane incision. I
made an initial groove, went uphill
with a diamond blade, and then
downhill with a safety blade to cre-
ate a flare measuring 2.2 mm on the
outside and 2.4 mm on the inside. I
performed a synechiolysis and lifted
the iris off the anterior capsule.
Again, in order to create space in the
anterior chamber I had used manni-
tol and globe compression prior to
beginning. I inserted the Malyugin
Ring, refilled the eye with OVD, and
used my bevel-down phaco tip from
Alcon (Fort Worth, Texas), which
keeps the OVD in the chamber. I
turned the tip upward in the trough
in order to sculpt the remainder of
the groove under low vacuum to
prevent OVD from being evacuated.
At this, the case was no longer dif-
ficult because we had addressed the
challenges from the nanophthalmos
and the small pupil. Again, after the
IOL was implanted, I was able to
easily remove the Malyugin Ring.
Both the original Malyugin
Ring and the new Malyugin Ring
2.0 work very well. This device has
helped me many times, and I would
even say that it has made me a bet-
ter and a safer surgeon. EW
Editors' note: Dr. Osher is professor of
ophthalmology, College of Medicine,
University of Cincinnati, and medi-
cal director emeritus, Cincinnati Eye
Institute. He has financial interests
with MST.
Contact information
Osher: rhosher@cincinnatieye.com
1
CDC Sharps Safety Complete Workbook, http://www.cdc.gov/sharpssafety/pdf/workbookcomplete.pdf;
CDC Stop Sticks Campaign, http://www.cdc.gov/niosh/stopsticks/sharpsinjuries.htm
Over 1000
sharps injuries
per day
Sustained by US
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workers
1
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