APRIL 23, 2022 | EYEWORLD DAILY NEWS | 9
ASCRS ANNUAL MEETING
DAILY NEWS
Dr. Gupta also offered pearls for
using iris hooks. Make paracentesis
incisions peripherally/posterior but aim
downward to allow planar insertion
of the hook to avoid tenting. Consider
placing hooks before overfilling with
viscoelastic to minimize hyperinflation
of the anterior chamber and steep
angle needed for hook placement. She
added that diamond configuration
saves time and provides adequate pupil
expansion.
The Malyugin ring is another
device that could be helpful in these
scenarios. This is a paperclip-like
device with eight-point iris fixation,
and it's available in two sizes (6.25
and 7.0). The Malyugin ring offers the
advantage of easy and fast insertion
and removal. However, it cannot be
used to help with capsule fixation, can
be difficult to remove in complex cases,
and may be difficult to insert with
extremely small pupils.
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continued from page 6
When using the Malyugin ring, she
said not to overfill the eye with visco-
elastic. If you can't clip the edge of the
iris with the ring, deliver it into the AC
and tuck under the iris. When the rhex-
is is already completed, avoid clipping
the rhexis edge with the Malyugin ring
by placing more viscoelastic under the
iris to tent the tissue. She added that
not all irises can handle a ring.
The femtosecond laser may also be
used with small pupils. It can be used
to place a precise rhexis, but it's only
functional in patients with pupils larger
than 3 mm. She suggested increasing
capsulotomy energy and modifying the
size to avoid iris touch.
Surgical planning in advance can
make small pupil cases easier, Dr. Gup-
ta said. It's important to think about
pressure gradient and iris support.
During the session, David Chang,
MD, shared his four best pearls for
phaco with zonulopathy.
1. Re-enlarge CCC diameter
2. Capsule retractors
3. Dispersive OVD to stretch PC
4. 3-piece IOL in sulcus (+CCC capture)
Relating to his first pearl of re-en-
larging the CCC diameter, Dr. Chang
said to avoid a small CCC. You may
have to make it on the small side at
first to complete the case, but don't
leave it that way. You can enlarge once
the lens is in, Dr. Chang said, because
then you know exactly how big to
make it.
Editors' note: Dr. Chang has no relevant
financial interests. Drs. Gupta and Shah
have financial interests with a variety of
ophthalmic companies.
