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    Clinical experience with a mechanical pupil dilator


    Key advantages of the Malyugin ring

    As noted earlier, I used to employ iris hooks during cataract surgery in patients with small pupils. In doing so, it was necessary for me to create four or five corneal incisions.

    Although I never experienced any problems with hooks, there is the risk that they might overstretch the iris sphincter and create iris defects. The main advantage of the Malyugin ring is that it can be inserted via the main clear corneal incision, eliminating the need for multiple incisions.

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    There is no need to widen the main incision. I use a 2.2 mm incision and can easily place the Malyugin ring through it. This obviously saves considerable surgical time and is less invasive than using iris hooks.

    The Malyugin ring also eliminates stretching or distorting of the pupil. Because it affords minimal contact with the iris, it is less likely to damage the iris sphincter than other rings or hooks. Perhaps not surprisingly, I no longer turn to hooks when I need to perform mechanical pupil expansion.

    The Malyugin ring is very easy to use thanks to its disposable injector, which aids placement of the ring around the edge of the pupil. Typically, the first three of the four paperclip-like scrolls are very easy to insert.

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    However, to facilitate insertion of the fourth scroll close to the main incision, I would advise using the injector and an Osher micromanipulator (MicroSurgical Technology, Redmond, WA), which is designed for the specific geometry of the Malyugin ring, through a second incision.

    After surgery, the same Osher micromanipulator can be used to remove the twelve o’clock scroll, while the injector can be used to quickly and smoothly remove the ring without trauma to the iris sphincter (Figure 2). Unlike other pupil-expansion devices, the injector can be disposed of once surgery is complete, eliminating the need for sterilisation and its associated costs.

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    Cedric Schweitzer, MD
    Cedric Schweitzer, MD, is an ophthalmologist based at the University Hospital Bordeaux in France.

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