The Use Of A Pupil Expander In Complex Combined Phacovitrectomy Surgical Procedures

To describe an easy and safe way to manage challenging surgery cases, such as small pupils, involving both  the anterior and the posterior segment of the eye.

Phacoemulsification , posterior chamber intraocular lens implantation and pars plana 25 gauge  posterior vitrectomy were performed under general anaesthesia at an Italian tertiary care hospital

Male, 35 years old with a traumatic white cataract with a small and undilatable pupil and inferior iridodialys, total retinal detachment with grade C type 4 PVR and subretinal strands. We performed a 1.8 mm phacoemulsification with Malyugin ring pupil expansion a 25G PPV with TDC EVA DORC system, 27G twinlight chandelier and illuminated transcleral depression. The mechanical pupil dilation obtained with the Malyugin ring was a true benefit for the whole surgical procedure.

 

 

Proper pupil dilation is fundamental to perform a safe and controlled cataract surgery, especially in complex cases with small pupils, morevover when it is a combined (anterior and posterior segment) procedure.

Malyugin ring pupil expander is likely the best option to achieve an optimal, regular and atraumatic pupil expansion without significant adverse effects and surgical complications, although in the hands of a well trained surgeon