Stürmer J, Scherrer M, Lansel N
Augenklinik Kantonsspital Winterthur, Schweiz.
Klin Monbl Augenheilkd. 2012 Apr;229(4):365-8. doi: 10.1055/s-0031-1299236. Epub 2012 Apr 11.
Inadequate mydriasis may cause major problems in phacoemulsification surgery. Usually 4 iris retractors are used to allow adequate pupillary dilatation. Implantation of a Malyugin ring to maintain a 6.25 mm pupil is a new alternative.
A Malyugin ring was used in 46 eyes of 39 patients (aged 80.1 ± 6.2 years). The ring is im- and explanted with a disposable shooter through the main incision. Indications for the use of the ring were inadequate mydriasis due to pseudoexfoliation (n = 27), intraoperative floppy iris syndrome (n = 5), the combination of PEX and IFIS (n = 11), extensive posterior synechiae (n = 2) or inadquate mydriasis after long-term pilocarpine treatment (n = 1).
In 44/46 eyes phacoemulsification with implantation of foldable posterior chamber lens was performed without complications. In 2 eyes with massive phakodonesis an Artisan anterior chamber lens had to be implanted after anterior vitrectomy because of total zonulolysis. There where no complications associated to the use of the device and with increasing experience duration of implantation as well as explantation was reduced to 2 - 4.5 min (median 2:51 min).
In cases of phacoemulsification surgery with inadequate mydriasis implantation of a Malyugin ring is a simple, safe and fast alternative to iris-retractors; it allows better pupil-size without additional stab incisions.
瞳孔散大不充分可能会导致白内障超声乳化手术中出现重大问题。通常使用4个虹膜拉钩来使瞳孔充分扩张。植入Malyugin环以维持6.25毫米的瞳孔是一种新的选择。
39例患者（年龄80.1±6.2岁）的46只眼睛使用了Malyugin环。该环通过主切口用一次性推送器植入和取出。使用该环的指征包括假性剥脱导致的瞳孔散大不充分（n = 27）、术中虹膜松弛综合征（n = 5）、假性剥脱与虹膜松弛综合征并存（n = 11）、广泛的虹膜后粘连（n = 2）或长期毛果芸香碱治疗后瞳孔散大不充分（n = 1）。
46只眼中的44只眼在植入可折叠后房型人工晶状体的情况下进行了超声乳化手术，无并发症发生。2只眼出现严重晶状体震颤，由于完全晶状体悬韧带溶解，在前段玻璃体切除术后不得不植入Artisan前房型人工晶状体。使用该装置未出现并发症，随着经验的增加，植入及取出的时间缩短至2 - 4.5分钟（中位数2:51分钟）。
在瞳孔散大不充分的白内障超声乳化手术中，植入Malyugin环是一种简单、安全且快速的替代虹膜拉钩的方法；它无需额外的穿刺切口就能使瞳孔大小更理想。
