Mastering Iris Expansion with the Malyugin Ring
Expanding the pupil is a crucial step in many complex cataract surgeries, and using a Malyugin ring can make the process more controlled and efficient. Here’s a step-by-step guide to ensure a smooth and safe procedure:
🔹 Step 1: Viscoelastic Injection
Begin by injecting viscoelastic into the anterior chamber to protect intraocular structures. Ensure proper distribution, including between the iris and the lens, to facilitate ring placement.
🔹 Step 2: Inserting the Malyugin Ring
- Load the ring into the injector and introduce it through the incision, being careful not to stress the iris.
- First, lateralize the ring to the right, gently hooking the iris while maintaining control.
- Next, repeat the process on the left, ensuring even expansion without excessive tension.
- Withdraw the injector smoothly, using a lateral maneuver to complete placement.
🔹 Step 3: Fine-Tuning for Proper Centering
- Use a stable hand position, holding instruments with a crab-claw grip for precision.
- Hook the iris at the appropriate points, taking a moment to optimize centration while protecting the corneal endothelium.
- Always check tissue metrics to confirm proper expansion and avoid unnecessary trauma.
🔹 Step 4: Safe Removal of the Malyugin Ring
- Unhook the ring systematically, starting with the loop closest to the incision.
- Use controlled lateral movements to avoid endothelial damage.
- When engaging the ring with the injector, position it in a “Y” shape for secure grasping before removal.
A meticulous approach ensures a successful pupil expansion, facilitating safer and more effective cataract surgery. Always prioritize precision, control, and tissue preservation.
👁️ What are your key considerations when using a pupil expansion device? Let’s discuss in the comments!