“The small pupil is a big problem for cataract surgeons, increasing the risk of complications that include iris trauma, capsular rupture, vitreous loss, and inflammation,” said Boris D. Malyugin, MD, PhD.
At the 2006 ASCRS Film Festival, Dr. Malyugin, professor of ophthalmology and deputy director, S. Fyodorov Eye Microsurgery Institution, Moscow, received the first-place award in the instruments/devices category for his video, “Russian solution to small-pupil phaco and tamsulosin floppy-iris syndrome,” that presented the pupil expansion ring he designed for atraumatic management of the small pupil.
At the 2017 ASCRS meeting, Dr. Malyugin was honored for his pioneering innovation and other contributions by being selected as the recipient of the Binkhorst Medal. His lecture, which was titled “Cataract surgery in small pupils: building the bridge over troubled waters,” provided a review of strategies for small pupil management.
Calming the waters
As he discussed the features and benefits of the new version of his pupil expansion ring, the Malyugin Ring 2.0, Dr. Malyugin noted, “So now the troubled waters of cataract surgery will be calm and safe for the patient and cataract surgeon.”
Through a series of videos, Dr. Malyugin demonstrated the use of techniques for addressing insufficient pupil dilation, including intracameral mydriatic medications, posterior synechiolysis, pupillary membranectomy, and microsphincterotomy. Turning to a discussion of mechanical techniques, he noted that iris hooks were historically the first devices to be widely used in small pupil cataract surgery. As a major drawback, however, the hooks could cause significant trauma to iris tissue as a result of creating a square pupil configuration.
“Given a square and a circle with the same diameter, the square exerts more stress on the surrounding tissue because it has a longer periphery,” Dr. Malyugin explained. “This brings us to the story of the rings.”