Ring Stretcher, High Power Manual Screw Ring Expander Finger Sizer Stick Adjust Ring Sizes 1-14

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Chang DF. Use of Malyugin pupil expansion device for intraoperative floppy-iris syndrome: results in 30 consecutive cases. J Cataract Refract Surg. 2008;34(5):835‐841. doi:10.1016/j.jcrs.2008.01.026 Potentially this will resolve itself on running in, but being at +80 I don't want to accelerate bore wear.

Akman A, Yilmaz G, Oto S, Akova YA. Comparison of various pupil dilatation methods for phacoemulsification in eyes with a small pupil secondary to pseudoexfoliation. Ophthalmology. 2004;111(9):1693‐1698. doi:10.1016/j.ophtha.2004.02.008Nderitu P, Ursell P. Iris hooks versus a pupil expansion ring: Operating times, complications, and visual acuity outcomes in small pupil cases [published correction appears in J Cataract Refract Surg. 2019 Feb;45(2):257]. J Cataract Refract Surg. 2019;45(2):167‐173. doi:10.1016/j.jcrs.2018.08.038 bolus intracameral mydriatic and local anesthetic [including 'epi-Shugarcaine' [4] (epinephrine 1:1000 and lidocaine 1%) described by Joel K Shugar [5], phenylephrine 1.5%, Mydrane (Thea Pharmaceuticals Limited, Newcastle-under-Lyme, UK)- lidocaine (1%), tropicamide (0.02%), and phenylephrine (0.31%)] My discussions with Hastings concluded that my 'expanders' were too short to expand the oil control rails and make them conform to the bore - hence the gap issue on the rails. ( incidentally Alan I did fit the 3 piece oil assembly rings alone on the piston and there was no difference - i.e 1 or 2 thou gap in places on each rail) . Usually, 3-4 hooks are used via self-sealing peripheral corneal/limbal paracentesis (1.5mm) incisions leading to a triangular or square-shaped pupil. The pupil is stretched with another instrument (iris pusher) and then the pupillary margin is engaged in the hooks. The hooks are removed after the surgical procedure. Challenges with these hooks include increased surgical time and fluid loss through the incisions which may accumulate over the cornea in deep-seated eyes causing increased reflections and compromised visibility. This is a type of flip and chop. In very small pupils, after hydrodissection, a part of the lens is brought up to the anterior chamber while part of it remains in the bag. A sufficiently large capsulorrhexis is mandatory for safe manipulation of the lens in the pupil and for bringing it out of the capsular bag. This lens now mechanically keeps the pupil dilated, The corneal endothelium is coated with cohesive OVD and the lens is now chopped. The energy delivery in the eye may be reduced with phaco power modulations, and the phaco is performed at the iris plane, not at the anterior chamber. Such maneuvers may protect from posterior capsular damage, but care should be taken to protect the corneal endothelium also.

It is prepared from thin nitinol wire and dilates the pupil to around 6.75mm. To position the device, manipulation with other instruments is needed. This device creates an octagonal pupillary opening. It does not pinch the iris margin. The speculum is inserted inside the eye using an inserter. This is used for stretching the pupil at 4 points. Initially, the dilator is introduced inside the anterior chamber through the single plane main wound (around 2.5 mm). The primary microhook engages the sub-incisional pupillary margin. The other 3 microhooks are also engaged at the pupillary margin and slowly simultaneous and symmetrical dilation at 4 points is achieved using this dilator. The pupil is held at maximal dilation for a few seconds and then the dilator is disengaged and removed. This creates multiple microsphincterotomies and makes the pupil to about 6-7 mm in diameter. Another version of the instrument with 2 microhooks is also available. The specific gravity of the material of Bhattacharjee ring (nylon 6.6 or nylon 6, specific gravity 1.14-1.35) is higher than water (specific gravity 1 ) or balanced salt solution (1.006) and Malyugin ring (polypropylene, specific gravity 0.9-0.91) is lighter. Thus, there is a theoretical possibility of inadvertent touch to the endothelium if Malyugin ring inadvertently disengages during cataract surgery. [29]

The affordable cost is an important advantage of iris hooks. The hooks may be placed at the axis of intended toric IOL placement, thereby marking the axis. As the exposure at these areas is maximum, the toric marks of the IOL are easily seen. Putting an iris hook just behind the phaco wound avoids tenting up of iris in front of the phaco probe, reduces the chance of iris prolapse, and increases visibility. When 4 iris hooks are used at 90° to each other, a diamond or quadrangular opening or pupil is made and the surgical exposure can be excellent. With experience, the time needed for insertion and removal of the iris hook can be reduced considerably. The tip has a curve to engage the pupillary margin. Both side port and main incision versions are available. Side port version has one c loop facing distally. Two such instruments can be used for pupillary stretching. The main incision (phaco incision) version has 2 C loops facing away from each other and these engage the sub-incisional and distal pupillary margin and the difference between C loops can be increased leading to pupillary dilation. We’ll show you a couple of oil ring details and how even a mild, normally aspirated street car engine can make more power, spin with less internal friction, and still deliver proper oil control.