Pupil expansion devices are an essential element of cataract surgery in cases of non-dilating pupils. An adequately sized capsulorrhexis with an adequate and appropriate exposure of the surgical space ensures the ease of surgery. Without the use of a proper pupil expansion device, a small pupil may cause complications such as sphincter tears, intraoperative bleeding, zonular dialysis and, in extreme cases with prolonged struggle, possibly even posterior capsular rent or nucleus drop. Prolonged surgical time and increased maneuvering may result in postoperative complications such as striate keratopathy, uveitis, secondary glaucoma, floppy iris, torn iris, atrophic iris, irregular pupil, endophthalmitis or cystoid macular edema, all resulting in a suboptimal surgical outcome and an unhappy patient.Currently available devices are designed to be placed either totally intraocularly (rings) or partially externally with the intraocular extension of the device holding back the pupil retracting the iris tissue (iris hooks, Assia pupil expander). The I-Ring is a new pupil expansion device from Beaver-Visitec that is designed to safely expand the iris tissue and enhance the surgeon’s field of view.
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