Management and outcomes of the small pupil in cataract surgery: iris hooks, Malyugin ring or phenylephrine?
Jbari, Ahmed Said
Cook, Erica Jane
Akhtar, Wasim Akhtar
AffiliationMoorfields Eye Clinic at Bedford Hospital
Royal Free NHS Foundation Trust
University of Bedfordshire
Christie NHS Foundation Trust
MetadataShow full item record
AbstractPurpose To investigate outcomes for small versus large pupils in cataract surgery using different pupil expansion techniques. Methods Retrospective case-series reviewing 20,175 patients’ cataract surgery electronic medical records at Moorfields Eye Clinic in Bedford Hospital NHS Trust from January 2010 to April 2020. Outcomes such as visual acuity (VA), intraocular pressure, intraoperative, post-operative complications were recorded and small pupil expansion device outcome. Results One thousand, four hundred twenty-six patients were identified as having small pupil (SP). Of these, 1110 patients (77.8%) had interventions to expand the pupil including 447 (31.3%) with intracameral phenylephrine (IC PE) alone, 194 (13.6%) with iris hooks and 469 (32.9%) with a Malyugin ring. The large pupil (LP) group had a statistically significant greater gain in VA than the SP group (p < 0.05). SPs had a significantly higher rate of intraocular complications including posterior capsular rupture (PCR) with vitreous loss (OR 2.75, p < 0.001). There was also a significantly higher rate of post-operative complications such as corneal oedema (OR 2.64, p < 0.001) and anterior uveitis (OR 2.11, p < 0.001) in the SP group. However, VA improvement and complications between the different pupil expansion groups showed no significant differences (p > 0.05) except for a greater rate of iris tears in the Malyugin group (p < 0.05). Conclusion To date, this is the largest reported case-series comparing Malyugin rings and iris hooks with other pupil expansion techniques. The various techniques to expand pupil size appear to be safe and equally effective in improving VA with a similar rate of complications except for a greater rate of iris tears with Malyugin ring.
CitationBalal S, Jbari A, Nitiahpapand R, Cook EJ, Akhtar W, Din N, Sharma A (2020) 'Management and outcomes of the small pupil in cataract surgery: iris hooks, Malyugin ring or phenylephrine? ', Eye, 35, pp.2714-2718.
The following license files are associated with this item:
- Creative Commons
Except where otherwise noted, this item's license is described as Yellow - can archive pre-print (ie pre-refereeing)
- Iris hooks versus a pupil expansion ring: Operating times, complications, and visual acuity outcomes in small pupil cases.
- Authors: Nderitu P, Ursell P
- Issue date: 2019 Feb
- Comparison of different pupil dilatation methods for phacoemulsification in eyes with a small pupil.
- Authors: Wang JD, Zhang JS, Li M, Mao YY, Mayinuer Y, Wan XH
- Issue date: 2022 Apr 18
- Use of Malyugin pupil expansion device for intraoperative floppy-iris syndrome: results in 30 consecutive cases.
- Authors: Chang DF
- Issue date: 2008 May
- Results of phacoemulsification with Malyugin Ring in comparison with manual iris stretching with hooks in eyes with narrow pupil.
- Authors: Wilczynski M, Wierzchowski T, Synder A, Omulecki W
- Issue date: 2013 Mar-Apr
- [Malyugin ring--an alternative in the treatment of a miotic pupil].
- Authors: Muşat O, Mahdi L, Gheorghe A, Burcea M, Cernat C, Cristescu R, Toma O, Radu A
- Issue date: 2014