Boris Malyugin, MD, PhD, redefined the practice of pupil expansion with the invention of the Malyugin Ring (MicroSurgical Technology). This relatively simple but ingenious device has helped thousands of surgeons perform cataract surgery in eyes with small pupils. Since the inception of this pioneering pupil expander, similar devices have been developed and launched. Below are a few alternatives shown in video.
VISITEC I-RING pupil expander
The Visitec I-Ring pupil expander (Beaver-Visitec International) is a stable device with a circular physiologic pupil opening allowing for intuitive surgical exposure. In this video, Roberto Pineda, MD, performs cataract surgery on a 70-year-old woman with a 5-mm pupil. Dr. Pineda utilizes the Visitec I-Ring, demonstrating the ease of its insertion, positioning, and disinsertion, and explains the atraumatic qualities of the device.
APX 200 PUPIL EXPANDING DEVICE
The APX 200 pupil expanding device (APX Ophthalmology) has a unique design with external corneal fixation and stabilization. It has the advantage of a reusable options, great surgical exposure, and small-incision insertion. In this video, P. Dee G. Stephenson, MD, FACS, demonstrates placement of the APX 200 to expand a small pupil.
BHATTACHARJEE PUPIL EXPANSION RING
The Bhattacharjee Pupil Expansion Ring, developed by Suven Bhattacharjee, MD, can be inserted through a 0.9-mm incision and appears relatively easy to remove. It seems to take a little work to position the device, but that is likely a learning curve that is easy to overcome.
Xpand NT Iris Expansion System
This video by Y. Ralph Chu, MD, demonstrates the use of a novel pupil expansion device called the Xpand NT Iris Expansion System (Diamatrix), which allows surgeons to create a femtosecond laser capsulorhexis and perform lens fragmentation in patients with small pupils. In this case, Dr. Chu utilizes the Victus laser (Bausch + Lomb) to perform the capsulorhexis and lens fragmentation under viscoelastic with a complete capsulotomy. The Xpand can be inserted through an injector and removed using the injector for easier handling and storage. Manual removal techniques for insertion and removal are also possible. What is especially nice about this device is that it is reusable, which helps with cost.