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ESCRS Binkhorst Medal Lecture focuses on challenges of small-pupil cataract surgery
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LISBON, Portugal — A small pupil, often an indicator of various systemic and/or local comorbidities, is a big problem in cataract surgery, associated with an increased complication rate.
“Every millimeter of pupil constriction increases our complication rate by 10%,” Boris Malyugin, MD, PhD, said during the Binkhorst Medal Lecture at the European Society of Cataract and Refractive Surgeons meeting.
The Malyugin ring (MicroSurgical Technology) was a breakthrough innovation for the management of small pupils. Malyugin first implanted it with the PMMA posterior chamber IOL designed by Svyatoslav Nikolayevich Fyodorov, and in September 2007, the ring entered the market.
Previous technologies included iris hooks, which are still a preferred option of several surgeons.
“They are an effective technology that keeps the iris in place, but I never really liked them, not only because they require extra incisions but also because they have a tendency to overextend the pupil. They form a square, the perimeter of which is longer than the perimeter of the circle, and might cause damage to the eye, leading to postoperative complications,” Malyugin said.
His ring is inserted through the main incision, provides eight points of fixation and does not overextend the iris tissue. It is now produced in a thinner, softer and more elastic polypropylene material, which is more gentle with the iris tissue and easier to handle and implant.
“I still use the older version with irises that are very fibrotic because you need some force to expand the pupil, but floppy iris syndrome is managed very well with the new device,” he said.
The ring, he said, is also well suited for femtosecond laser-assisted cataract surgery.
Because “challenges lead to innovation and innovation leads to further innovation,” Malyugin said he is happy and proud that other rings, inspired by his ring, are now produced by other companies. - by Michela Cimberle
Reference:
Malyugin B. Cataract surgery in high-risk eyes: lessons learned. Binkhorst Medal Lecture 2017. European Society of Cataract and Refractive Surgeons meeting; Oct. 7-11, 2017; Lisbon, Portugal.
Disclosure: Malyugin reports he receives royalties from MicroSurgical Technology.