Ring Stretcher, High Power Manual Screw Ring Expander Finger Sizer Stick Adjust Ring Sizes 1-14

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ensuring maximal pupillary dilation with the use of mydriatic drops including tropicamide and phenylephrine, This is described by Dr. John Milverton, of Sydney, Australia. This is a device with a 7 mm internal diameter made from polyurethane. The groove at the outer surface of the device engages the pupillary margin. It may be inserted inside the anterior chamber with a forceps or an injector through the main port which has to be mildly enlarged to accommodate both the phaco/irrigation aspiration handpiece and the portion of the ring which protrudes outside the phaco wound. The device is first inserted into the anterior chamber which has been filled with OVD. The proximal-most area of the ring is first engaged, then adjacent areas are progressively engaged in the pupillary margin. The protruding portion of the ring helps in the removal of the ring after its use. The pupillary margin may get caught in the device resulting in iris injury, but excellent pupillary dilation is usually achieved. The Haynes Manual @ pg.2-36 simply says to stagger the ring gaps around the Upper 180 degrees of each piston the the oil control ring gap facing up

Intraoperative further reduction in pupillary dilation likely related to prostaglandins release or iris touch with instruments,

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This is a hydrogel device which in its dehydrated oval form can be placed in the anterior chamber through a 3 mm incision. The device engages the pupillary margin via flanges and enlarges in size with hydration. It can be manipulated to aid in its expansion. It is removed after the placement of IOL through the same incision. Canabrava S, Rezende PH, Eliazar GC, et al. Efficacy of the Canabrava Ring (pupil expansion device) in cataract surgery for eyes with small pupils: the first 30 cases. Arq Bras Oftalmol. 2018;81(3):202‐211. doi:10.5935/0004-2749.20180042 It is described by John Graether from Iowa, USA. [8] This is a clear soft silicone ring. It has a circumferential groove for engaging the pupillary margin. It is inserted inside the eye using a preloaded sterile device. It dilates the pupil to 6.3 mm. The ring is incomplete and a strap connects the ends of the ring. This is inserted inside the eye using an insertion instrument and iris glide-retractor. Rauen M, Oetting T. Partial retraction of Malyugin pupil expansion device to improve safety during ring removal. J Cataract Refract Surg. 2010;36(3):522‐523. doi:10.1016/j.jcrs.2009.10.034

There is a higher chance of trauma to the anterior capsular rim/capsulorrhexis edge with instruments. An anterior capsular tear may extend beyond the equator causing a posterior capsular rent (PCR). The affordable cost is an important advantage of iris hooks. The hooks may be placed at the axis of intended toric IOL placement, thereby marking the axis. As the exposure at these areas is maximum, the toric marks of the IOL are easily seen. Putting an iris hook just behind the phaco wound avoids tenting up of iris in front of the phaco probe, reduces the chance of iris prolapse, and increases visibility. When 4 iris hooks are used at 90° to each other, a diamond or quadrangular opening or pupil is made and the surgical exposure can be excellent. With experience, the time needed for insertion and removal of the iris hook can be reduced considerably. mydriatic with or without NSAID in the irrigation fluid to maintain the dilation and prevent miosis- adrenaline, Omidria® (Omeros Corp., Washington, USA)-phenylephrine 1% & ketorolac 0.3%. Omidria® has been approved by the FDA (Food and Drug Administration, USA) for use in the irrigating solution during cataract surgery to maintain the pupillary dilation (which has been already achieved) by preventing miosis and to prevent pain after surgery. The piston ring gaps should be evenly distributed around the circumference of the piston, staggered at intervals of approximately 120°. WHAT DO YOU SUGGEST FOR ORIENTATION OF THE FIRST TWO RINGS And THEN THAT THIRD (bottom) OIL RING-especially how and where to to place the top and bottom rings OF THE OIL RING ASSEMBLY ( called "rails" at DEVES )see http: www.deves.com/oilring_inst.htmlLess visibility of the peripheral lens and the placement of the tip of certain instruments. This.may increase the risk of complications including iris trauma (including chafing, sphincter tear, iridodialysis), hyphema, PCR Nderitu P, Ursell P. Iris hooks versus a pupil expansion ring: Operating times, complications, and visual acuity outcomes in small pupil cases [published correction appears in J Cataract Refract Surg. 2019 Feb;45(2):257]. J Cataract Refract Surg. 2019;45(2):167‐173. doi:10.1016/j.jcrs.2018.08.038 My discussions with Hastings concluded that my 'expanders' were too short to expand the oil control rails and make them conform to the bore - hence the gap issue on the rails. ( incidentally Alan I did fit the 3 piece oil assembly rings alone on the piston and there was no difference - i.e 1 or 2 thou gap in places on each rail) . The JT-RS151P is perfect for an accurate and easy stretching of all kinds of rings, including some types of stones. Before you stretch your ring, please make sure that you anneal it in advance to avoid unnecessary destruction. Push the lever until there’s some resistance. When you feel resistance, this is when you should be careful. Apply less pressure at this point.

It is a flexible hexagonal plastic (Polyimide) ring with a 0.075 mm (75 microns) profile having notches at corners and flanges at sides, all disposed in a single plane. The disposable 6.5 mm B-HEX provides a 5.5 mm expanded pupil. It is preloaded in a transparent single-use carrier with an ergonomic handle that delivers the device sterile at the incision. Akman A, Yilmaz G, Oto S, Akova YA. Comparison of various pupil dilatation methods for phacoemulsification in eyes with a small pupil secondary to pseudoexfoliation. Ophthalmology. 2004;111(9):1693‐1698. doi:10.1016/j.ophtha.2004.02.008 In another study, [27] both Malyugin ring and I ring was noted to achieve 'smooth and atraumatic pupillary dilatation'. However, a case report noted that circular I ring device caused less distortion of the pupil (11%) compared to diamond-shaped Malyugin ring (49%). [28] preoperative nonsteroidal anti-inflammatory drug (NSAID) drop to possibly prevent intraoperative miosis, Various strategies have been employed in such patients to overcome the challenges and to dilate the pupil.

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Agarwal's modification- A suture is passed through the leading coil so that the device can be retrieved in cases with suspected posterior capsular rupture. [11] Bhattacharjee S. Pupil-expansion ring implantation through a 0.9 mm incision. J Cataract Refract Surg. 2014;40(7):1061‐1067. DOI:10.1016/j.jcrs.2014.05.003