Published online Oct 16, 2019. doi: 10.5318/wjo.v8.i1.1
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.
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.