Pupil expander manages unique needs of small pupils

Take-home message: A pupil expansion device is flexible, yet stable and can easily be inserted and removed for cataract surgery procedures.

By Nancy Groves; Reviewed by Roberto Pineda, MD

Boston-A pupil expansion device (I-Ring Pupil Expander, Beaver-Visitec) is an innovative step in helping surgeons manage small pupils during cataract surgery, said Roberto Pineda, MD.

“It’s an incredibly valuable device for many of our cataract surgery patients,” said Dr. Pineda, director, Refractive Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston. “I think it provides better stability than a lot of the current ring-like devices.

“It’s very flexible and can be easily inserted into the eye through the same cataract incision, down to a 2.2-mm incision,” he added. “On average, the pupil is 6.4 to 6.5 mm with this device, and that provides adequate dilation for the vast majority of cases. Also, the device can be placed in the pupil margin a little more quickly than some of the other devices.”

Testing it out

Dr. Pineda was one of several surgeons invited to test prototypes of the ring and provide feedback. Although he was initially skeptical about how this new device would differ from others, he discovered features that help increase and maintain a larger pupil size and reduce the risk of complications during a procedure.

“What’s really nice about the device is that it’s flexible, but stable enough so that during different stages of cataract surgery, the ring doesn’t move around,” he said. “Even in cases where there is some intraoperative floppy iris syndrome, where the iris may move or billow, I’ve been very impressed with the device’s ability to remain stable. Some of the other devices, whether they’re hooks or other ring-like devices, are much more prone to movement.”

The single-use device has safe positioning holes to ensure that a Sinskey hook cannot contact the iris. Fixed-height channels along the outer edge are designed to avoid distortion or pinching of the iris while the ring is being engaged or removed and also provide vertical stability of the iris diaphragm. The channels also aid in engagement and disengagement.

The device also has living hinges, which enhance flexibility and allow reliable folding during insertion and removal. The hinges can be easily grasped with the inserter. The single-use device can be inserted with one hand.

“Another of the novel features is the way the [device] is removed from the eye. It is very atraumatic and slick,” Dr. Pineda said.

Once the device is ready for removal, it can easily be retracted up the injector by capturing the ring on the hinge located adjacent to the channel. This allows the injector to pull the ring up and remove it.

Also, the ring is a vibrant green color that makes it stand out against the background, which can be helpful during surgery, Dr. Pineda said.

“People who have used other devices and tried this are very impressed with the simplicity of the device,” he said. “It has simplified the process, the ease of insertion, and the ease of removal compared with current devices on the market.”

Roberto Pineda, MD

E:Roberto_Pineda@meei.harvard.edu

Dr. Pineda is a consultant for Beaver-Visitec.