Binkhorst lecturer focuses on challenges of small pupils during cataract surgery
LOS ANGELES — Cataract surgery in patients with small pupils can be challenging, but several techniques and surgical devices can help make the procedure more successful, according to a speaker here.
“A small pupil may be challenging even with the newest state-of-the-art technology, like femto laser-assisted cataract surgery. There are two possible scenarios: The pupil is small from the very beginning, or it starts to constrict during surgery. In both of them, the [Malyugin] ring will help you to complete the procedure and make it uneventful,” Boris E. Malyugin, MD, PhD, said during the Binkhorst Lecture at the American Society of Cataract and Refractive Surgery meeting.
Boris E. Malyugin
Small pupils have been a longtime challenge for cataract surgeons, he said. They can be associated with increased complication rates, such as iris trauma, capsule rupture, vitreous loss and inflammation.
There are several surgical techniques that can be helpful in small pupil cataract surgery. For example, in some cases it can be challenging to access the lens, so pupil stretching can help the surgeon extend the pupil to access the lens and proceed with further lens extraction, Malyugin said.
However, the use of a Malyugin ring in cataract surgery may often be the best option for extending and opening the pupil, he said.
Malyugin developed the ring, which is square in shape and consists of four iris-retaining rings, to hold the iris open at equidistant points.
“One of the major advantages of the device is the number of iris-retaining points allowing full control stretching of the pupil, with minimal trauma to the iris tissue,” he said.
By 2014, the Malyugin ring had been used in 1 million cataract patients worldwide during cataract surgery. Last year, a second-generation Malyugin ring was developed. It is thinner and features a redesigned injector and holder to make it easier to inject and remove after surgery, he said. – by Robert Linnehan
Malyugin BE. Cataract surgery in small pupils: Building the bridge over troubled waters. Presented at: American Society of Cataract and Refractive Surgery annual meeting; May 5-9, 2017; Los Angeles.
Disclosure: Malyugin reports he is a member of the speakers bureau and has travel expenses reimbursed by Alcon/Novartis, Bausch + Lomb/Valeant and Bayer; receives consultant fees and is a member of the speakers bureau for Carl Zeiss Meditec; and earns a royalty or other financial gain from Microsurgical Technology Inc. and Morcher GmbH.