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    Know your options when expanding a pupil


    Small study

    Transillumination defects caused by I-Ring use. Courtesy of Brian A. Hunter, MDDr. Hunter initially thought he was seeing more TIDs from the I-Ring than from the Malyugin Ring. The I-Ring has a slightly larger profile on the pupil, so it seems reasonable that it could cause more defects. None of the defects he noted were visually significant, but they were large enough to be visible during an exam, even if patients did not see any effect.

    “I decided to do a small study with my own patients, looking to see just what kind of iris defects they had from the two devices,” Dr. Hunter said. “At least in my practice, results between the Malyugin Ring and the I-Ring were very similar, not as significant as I thought I was seeing.”

    Dr. Hunter followed 14 patients, 7 with the I-Ring and 7 with the Malyugin Ring. Outcomes were inflammation, TIDs, and pupil shape 1-day postop and 14-days postop. Patient demographics were similar between the 2 groups, as were the pre-op pupil size and cataract grade.

    Transillumination defects caused by Malyugin Ring. Courtesy of Brian A. Hunter, MDPostop results were similar. On day 1, the I-Ring had a mean of 1.5 cells versus 1.3 cells for the Malyugin Ring. Both rings had a single TID. The I-Ring had 2 pupil defects and the Malyugin has zero defects.

    On day 14, the I-Ring had no cells vs. 0.1 cells for the Malyugin Ring. The I-Ring had 1 TID, the Malyugin Ring had 2. Neither ring showed any pupil defects.

    “The I-Ring works well, though no one device is right for every surgeon or patient,” Dr. Hunter said. “I would encourage more people to use the I-Ring, especially those (physicians) who are in training. You get better outcomes without the steep Malyugin Ring learning curve. Especially when you are training residents, the I-Ring is a much better way of getting (residents) to do those harder cases earlier.”



    Brian A. Hunter, MD

    P: 520-293-6740

    E: [email protected]

    This article was developed based on a presentation that Dr. Hunter delivered at the 2016 American Society for Cataract and Refractive Surgery annual meeting.

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