Difficult Cases - Flomax with Bound Down Pupil
Alan Aker, MD, presents a bound down pupil in a patient who was also on Flomax. Rather than stretching the pupil with an Beeler Iris Retractor, the surgeon makes several paracentheses for placement of iris clips. After achieving good visualization, Dr. Aker proceeds with capsulorhexis and IOL implantation.
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Comments (4)
Would love to see the full case if you dont mind. Great case!
I tried using the Malyugin ring years ago and found it interfered with my phaco flip approach. This same difficulty was found when using the Graether system from Eagle Vision. Both devices were tried because we felt they would be more efficient than iris clips. Nevertheless, because of the safety that can be achieved with phaco flip, I think the additional time it takes to insert the iris clips is more than justified. Regarding the comment of ECCE vs small incision phaco, I would reply that ECCE in some hands may be the safer approach. The downside of the larger ECCE incision is the danger of falls in the elderly patient. Years ago, I treated a number of patients who had lost their IOL and prolapsed iris following either falls or blunt trauma to an eye with the larger ECCE wounds. When we went to the smaller sutureless approach about 20 years ago, we had a patient fall at home the day of surgery. This occurred within the first 50 cases of our sutureless approach with a small incision. Badly bruised around the eye, we were extremely pleased (and surprised) to find the patient with 20/40 uncorrected VA as well as a round pupil and an intact wound. That pretty much convinced me of the benefits of our smaller incision surgery. Alan Aker
whats wrong with a Malyugin ring?
In my opinion ECCE is safer