Pupil expansion device gently deals with small pupil problems during cataract surgery

Issue: October 10, 2015

BARCELONA — A new pupil expansion device allows a safer, gentler approach to intraoperative floppy iris syndrome, pseudoexfoliation and small pupils during surgery.

The I-Ring pupil expander (Beaver Visitec) is made of soft polyurethane, as opposed to the stiffer polypropylene more commonly used in pupil expansion devices. It is preloaded in an inserter and injected through the phaco incision.

Kenneth R. Kenyon

“There are four positioning holes that allow it to be engaged with a Sinskey hook and gently driven into position, embracing the iris for a full 360°. At the conclusion of surgery, it is simply disengaged, re-grasped with the injector and withdrawn into it,” Kenneth R. Kenyon, MD, said at the European Society of Cataract and Refractive Surgeons meeting here.

Small pupil problems occur in approximately 10% of the cataract surgery population, commonly in men.

“I now utilize this device in my everyday surgery and have residents and fellows using it. It is safe, reliable, consistent and requires no learning curve,” Kenyon said.

Mainstream use is in cataract, but the device has advantages over iris hooks and classic rings for IOL exchange, trauma and reconstructive surgery.

“The soft material is very gentle on the iris tissue and never causes issues with catching, pinching and tearing when we try to remove it. The ease of engagement and disengagement with these small positioning holes is also a safety feature because there is no potential for the Sinskey hook to catch the iris tissue itself. Finally, sometimes when withdrawing iris rings, they can twist and grab the iris or flip up and touch the corneal endothelium, while this ring always stays on the same plane and avoids distortion or damage to the iris or to the endothelium,” Kenyon said. – by Michela Cimberle

Disclosure: Kenyon is consulting medical director of Beaver Visitec.