The solution to the small-pupil problem
I developed the Malyugin ring (Micro Surgical Technology) as a solution for such difficult eyes. It is estimated that 5% of patients presenting for FLACS have small pupils—defined as ones with diameters smaller than 5.5 mm—and require a pupil expansion device intraoperatively.3
The square-shaped ring is an ideal pupil expansion tool in these situations. The device, which is available in diameters of 6.25 and 7.0 mm, consists of four circular scrolls that provide eight points of fixation to facilitate uniform pupil dilation.
A standout benefit of the device is the gentle, evenly dispersed contact made with the iris, thus minimising the likelihood of iris sphincter damage, as seen with other expansion rings. Furthermore, as it is introduced into the eye via an injector that is inserted into the primary corneal incision, it ensures there is no need to create additional incisions, as is neccessary with iris hooks.