Retrospective Cohort Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Ophthalmol. Oct 16, 2019; 8(1): 1-6
Published online Oct 16, 2019. doi: 10.5318/wjo.v8.i1.1
Series of cataract surgeries with I-ring pupil expansion ring
Kenneth Lu, Martin Garcia, Jack Tian, Rustum Karanjia
Kenneth Lu, Martin Garcia, Jack Tian, Rustum Karanjia, Doheny Eye Institute, University of California, Los Angeles, CA 91007, United States
Author contributions: Lu K and Karanjia R designed the study; Garcia M and Tian J collected the data; Lu K prepared the manuscript.
Supported by a research grant from Beaver-Visited International, the manufacturer of the I-ring.
Institutional review board statement: The UCLA Institutional Review Board has approved the above-referenced study.
Informed consent statement: Since this was a retrospective review of cases already performed with no release of any personal information, our institutional review board has waived the need for informed consent of the specific patients.
Conflict-of-interest statement: The authors do not have any financial interest in the company or the device.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Kenneth Lu, MD, Assistant Professor, Doheny Eye Institute, University of California, Los Angeles, 622 W. Duarte Rd, Suite 101, Arcadia, CA 91007, United States.
Telephone: +1-626-2549010
Received: May 17, 2019
Peer-review started: May 20, 2019
First decision: May 30, 2019
Revised: August 28, 2019
Accepted: October 3, 2019
Article in press: October 4, 2019
Published online: October 16, 2019

The retrospective review of I-ring pupil expansion ring use is designed to examine the patient characteristics and associated surgical challenges in a clinical practice. The hypothesis is that I-ring provides a necessary additive tool in dealing with challenging cataract surgeries with small pupils.


To document the safety profile and use of I-ring pupil expansion ring in a clinical practice.


A retrospective chart review of 12 consecutive cases within the same year (2016) of cataract surgeries employing I-ring pupil expansion ring (Beaver-Visitec, International) by a single surgeon at the same ambulatory surgical center was conducted. Demographic, pre-op, intra-op, and post-op data were recorded. Total number of cataract cases performed was also recorded.


8 of 12 cases were planned I-ring cases. 1 case was decided intraoperatively when femtosecond laser caused the pupil to shrink. The other 3 cases were also decided upon intraoperatively when pupil was deemed to be small. 7 patients had IFIS from Flomax use. 2 patients had pseudoexfoliation syndrome as the cause of small pupil. 2 patients had narrow angles with brunescent cataracts. 2 patients had pre-op partial zonular dehiscence. 1 patient had 360o of posterior synechiae. 2 cases had ruptured posterior capsule that required anterior vitrectomy. No complications were attributed to the pupil expansion ring. A total of 296 cataract surgeries were performed that year by the surgeon, making the rate of pupil ring use 4.1%.


Small pupil requiring pupil expansion ring during cataract surgery is often associated with other challenges, such as brunescent cataract, zonular weakness, and posterior synechiae in this series. I-ring helped to reduce at least one challenge in these difficult cases.

Keywords: Malyugin ring, I-ring, Small pupil, Pseudoexfoliation syndrome, Cataract, Iris retraction, IFIS, Zonular dehiscence, Challenging cataract surgeries, Pupil expansion device

Core tip: Pupil expansion rings are not new devices, however, to date, there are no clinical series that examines the nuanced factors that go into the decision and use of I-ring. This study provides a front-line peek at the use of I-ring.