As these case studies demonstrate, the second-generation Malyugin ring is a versatile pupil expansion ring with high efficacy in FLACS. Having used it on a variety of classically difficult eyes and in complicated surgical cases, it remains the device I can safely turn to, in order to ensure predicable and effective pupil expansion when other techniques fail.
Studies involving the ring, such as an 850-patient trial conducted by Conrad-Hengerer et al, support my own personal observations. The German study found that cases with 5.5-mm pupils or smaller required a ring 68% of the time.
In short, the device is poised to help bring about a paradigm shift in FLACS, allowing the procedure to become suitable and safe even in those with notoriously difficult eyes.