ications and in as much as 25% of the general patient population, says
Steven Silverstein, MD, FASC, an ophthalmic surgeon in Kansas City,
Mo. Plus, there are plenty of patients whose pupils don't dilate fully or
don't dilate to the extent that they did during pre-op clinic visits.
Maintaining pupillary dilation improves access to the eye and visuali-
zation of delicate anatomy, factors that decrease risk of posterior cap-
sular tears, zonular damage and vitreous loss, and make cataract
removal easier and safer. It also lets surgeons perform complex cases
more efficiently. Surgeons have plenty of available options to keep
pupils dilated during surgery, from hooks and rings to pharmaceutical
agents. The optimal choice for your facility demands striking a balance
between cost and clinical efficacy.
• Iris hooks. Reusable iris hooks don't add to case costs, but the ini-
tial capital expenditure will run your facility a couple hundred dollars.
A small stab incision is made in the limbus, through which surgeons
insert 4 hooks to maintain pupil dilation. In patients with IFIS, the iris
tends to prolapse out of the wound, which can be prevented by plac-
ing the hooks in a diamond configuration underneath the main tempo-
ral incision, says ophthalmic surgeon Nick Mamalis, MD, co-director
of the Intermountain Ocular Research Center in Salt Lake City, Utah.
• Iris rings. Single-use rings cost approximately $125 and reusable
options run approximately $50 per use. Surgeons insert ring-type
devices through a clear corneal incision to create and maintain pupil
dilation. There are several models available that are largely effective
in giving surgeons the space they need to operate. Surgeons must
decide which design and delivery method — a circular or square dila-
tion and inserter or separate injector — works best in their hands.
During surgery, surgeons must be aware of the ring's position on the
pupil, so they don't dislodge the device when sliding instruments into
and out of the eye.
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