Both the XpandNT and the
Iris Expander provide the
largest pupillary aperture, says
Steven Silverstein, MD, FASC,
an ophthalmic surgeon in
Kansas City, Mo. He adds that
the XpandNT allows for ideal
centration, particularly in
eccentric, or otherwise distort-
ed pupils, especially those with
traumatic sphincter rupture.
Dr. Miller says pupil rings are
typically safer to use than iris
hooks, with which surgeons
have a tendency to overstretch
the iris. Still, he says, the
devices aren't without inherent
risk.
Warns Dr. Silverstein,
"Surgeons must be careful
when inserting and removing any mechanical device in order to
avoid causing iatrogenic iris trauma or permanent iris cosmetic dis-
tortion."
Dr. Hamilton echoes that word of caution. "These are incredible
devices that work exceptionally well, but they're not without issue,"
he says. "Iris manipulation releases proinflammatory mediators,
which increase the risk of cystoid macular edema. It's not something
we do without seriously considering the consequences."
J A N U A R Y 2 0 1 9 • O U T PA T I E N T S U R G E R Y. N E T • 1 1 3
• WIDE-EYED Surgeons need clear visualization to make the cap-
sulorhexis, remove the cataract and implant an IOL.
