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

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Sharma VK, Trehan HS, Raji K, Dhar SK. New use of a pupillary expansion ring to avoid intraoperative positive vitreous pressure during triple procedures. J Cataract Refract Surg. 2019;45(5):544‐546. doi:10.1016/j.jcrs.2019.01.014 Perhaps I am over worrying - if I hadn't used an LED light behind the rings I would never have noticed !

The Haynes Manual @ pg.2-36 simply says to stagger the ring gaps around the Upper 180 degrees of each piston the the oil control ring gap facing up Pupil expansion devices Hydroview Iris Protector Ring (Grieshaber & Co. AG Schaffhausen, Schaffhausen, Switzerland) Less visibility of the peripheral lens and the placement of the tip of certain instruments. This.may increase the risk of complications including iris trauma (including chafing, sphincter tear, iridodialysis), hyphema, PCR Agarwal A, Malyugin B, Kumar DA, Jacob S, Agarwal A, Laks L. Modified Malyugin ring iris expansion technique in small-pupil cataract surgery with posterior capsule defect. J Cataract Refract Surg. 2008;34(5):724‐726. doi:10.1016/j.jcrs.2008.01.024 Potentially this will resolve itself on running in, but being at +80 I don't want to accelerate bore wear.

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Malyugin ring may offer easier and faster insertion and removal, and when carefully used iris trauma is minimal. [23] A study [9] on 30 eyes using Malyugin ring noted minor hyphema in 1 eye, spontaneous disengagement of the device in 1 eye (one scroll was not engaged properly to the iris during its positioning), minor sphincter tears visible in slit-lamp in 5 eyes (pupil was round and reactive), iris chafing and transillumination defect in 8 eyes, and high intraocular pressure in 3 eyes. Other challenges noted in the study included temporary deformation of the device during loading or injection which might have been related to insufficient cooling (immediate use within 5 minutes of flash sterilization). Entanglement of the side scrolls was noted in one case, which needed removal of the device and insertion of a new one. [9] Canabrava S, Rezende PH, Eliazar GC, et al. Efficacy of the Canabrava Ring (pupil expansion device) in cataract surgery for eyes with small pupils: the first 30 cases. Arq Bras Oftalmol. 2018;81(3):202‐211. doi:10.5935/0004-2749.20180042 This ring has been devised by Dr. Steven B Siepser from Philadelphia, USA. This is similar to the Hydroview iris protector ring. It met FDA guidelines in 2016 and was clinically launched in 2017. This is an irregular oval hydrogel ring which expands on hydration.

There is a higher chance of trauma to the anterior capsular rim/capsulorrhexis edge with instruments. An anterior capsular tear may extend beyond the equator causing a posterior capsular rent (PCR). After using these hooks/methods, multiple sphincterotomies may be noted and the pupil may appear dilated. The pupil in such cases may be constricted intraoperatively using gentle centripetal strokes over iris with blunt instruments including Lester hook and intraoperative miotic agents (including pilocarpine). However, in most cases, the pupillary sphincter is not damaged till the full radial extent, and pupils retain a good cosmetic appearance and good pupillary response to light and accommodation. In the immediate postoperative period, miotic agents may be considered to prevent iridocapsular adhesion/synechia. In cases with severe iris manipulation, frequent topical steroids and close observation are must in the immediate postoperative period and oral/intravenous steroids may be added in a case-based approach. Malyugin B, Anisimova N, Antonova O, Arbisser LB. Simultaneous pupil expansion and displacement for femtosecond laser-assisted cataract surgery in patients with lens ectopia. J Cataract Refract Surg. 2018;44(3):262‐265. doi:10.1016/j.jcrs.2018.01.014 preoperative nonsteroidal anti-inflammatory drug (NSAID) drop to possibly prevent intraoperative miosis,

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SOMEBODY Please Tell me how it's really done and help me with those Green/Red colors-they gotta mean something! Inadvertent placement of one haptic of intraocular lens (IOL) in the capsular bag and the other in sulcus which predisposes to iris chafing, inflammation after surgery, and concentration of the IOL after capsular healing 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) . A study [21] on 40 eyes noted that among iris hooks, Morcher ring, Beehler hooks, and pupil stretching; iris hooks, followed by Morcher ring had longest surgical times, though these achieved stable pupillary dilation throughout the surgery. Morcher ring caused the least iris trauma. Beehler pupil dilator and pupil stretching were associated with fast surgery. [21] The piston ring gaps should be evenly distributed around the circumference of the piston, staggered at intervals of approximately 120°.