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EW SHOW DAILY 8 ASCRS News Today Sunday, May 7, 2017 Iris hooks were historically the first device to be used in small pupils in cataract surgery, Dr. Malyugin said, noting that he prefers to use specially designed iris capsule hooks. The major drawback of an iris hook is in relation to the geometry of the pupil because it is square and not round. This causes tissue to be stressed and traumatized. Dr. Malyugin discussed the Ma- lyugin ring and other ring devices. Many people have asked where he got the idea for the Malyugin ring, and he said that in a closed system, the total energy of the system is conserved. He thinks that ophthal- mology is a closed system with ideas spiraling around. An advantage of the ring is that there are a number of iris retaining points, which help cause minimal trauma to iris tissue. Dr. Malyugin spoke about winning an award at the ASCRS Film Festival in 2006 for his video on the Malyugin ring, and he mentioned its first appearance in peer-reviewed literature, which showed the Malyu- gin ring to have advantages in intra- operative floppy iris syndrome (IFIS). Over time, there have been improve- ments in the design of the ring, and the injector has been modified. In 2014, the Malyugin ring hit the milestone of having helped more than 1 million cataract patients all over the world. "From history, we know innova- tions come in cycles," Dr. Malyugin said. Just last year, the Malyugin ring 2.0 was released with improved elasticity, the injector and holder redesigned, and with the ability to be inserted into a small incision to allow the device to be used in a variety of clinical situations. Still, Dr. Malyugin noted that small pupils may be challenging even with the newest state of technology. EW Editors' note: Dr. Malyugin has finan- cial interests with MicroSurgical Tech- nology (Redmond, Washington). by Ellen Stodola EyeWorld Senior Staff Writer systemic and/or local comorbidities, including but not limited to zonular pathology, blood-aqueous barrier disruption, and IOP spikes. Small pupils are usually associated with an increased complication rate, Dr. Malyugin said, like iris trauma, capsular rupture, vitreous loss, and inflammation. There are a number of surgical techniques to manage small pupils in cataract surgery. One good option is to deliver a mydriatic agent right into the anterior chamber. The direct contact of the agent with the iris tissue provides stable mydriasis, he said. This technique, however, may not work for all patients, so other strategies are needed. In some cases, it is quite chal- lenging to access the lens, and in these patients, there may not be enough pupil size to proceed with surgery, Dr. Malyugin said, adding that pupil stretching can help ex- pand and proceed with surgery. Dr. Malyugin delivered the lecture following the Opening General Session B oris Malyugin, MD, PhD, Moscow, Russia, delivered this year's Binkhorst Lec- ture on "Cataract Surgery in Small Pupils: Building the Bridge Over Troubled Waters." Dr. Malyugin first discussed Cornelius Binkhorst, MD, for whom the lecture is named, and his contributions to ophthalmology. He then went on to discuss Svyatoslav Fyodorov, MD, radial keratotomy, and the formation of the S.N. Fyo- dorov Eye Microsurgery Complex. Dr. Malyugin spoke about the problem of small pupils in cataract surgery, which he said has been a big challenge for surgeons for many centuries. Poor mydriasis is not purely a geometrical issue, he said. Rath- er, this is an indication of various Binkhorst Lecture highlights small pupils in cataract surgery Dr. Henderson presents Dr. Malyugin with his award following his Binkhorst Lecture. Miyuki Nagahara, Teaching Hospital University, Tokai University, was the winner of Saturday's EyeWorld drawing for a Nike Apple Watch. Congratulations! EyeWorld Educational Events Winner

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