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Solomon Ross, Bethany Markowitz; A Comparison of Biplanar Cataract Incision Postoperative Architecture Involving Malyugin Ring Insertion as Performed by a Resident Surgeon. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1820.
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The biplanar clear corneal incision provides intraocular access for phacoemulsification and has architecture designed to remain watertight during healing. Inserting large-diameter instruments, such as the phaco handpiece and lens cartridge, can induce wound architecture changes. Another tool often inserted through the main wound is the Malyugin Ring Introducer. In this study, the wound architectural changes resulting from insertion of the Malyugin Ring Introducer for ring placement and removal were compared to cases where a ring was not employed, as performed by a resident surgeon.
Cataract surgery was performed by a resident surgeon on 18 eyes. All eyes had a 2.4mm temporal biplanar clear corneal incision, no eyes had visible intraoperative wound architecture changes, and all were Seidel negative at the first postoperative visit. A 6.25mm Malyugin Ring was used to dilate the pupil in 5 of the cases; 13 of the cases did not require insertion of a Malyugin ring. An anterior segment OCT 5-Line Raster scan was performed on postoperative day 1, using the Zeiss Cirrus HD-OCT. The architecture of the corneal wound was examined for abnormalities: wound gape, endothelial detachment, and endothelial misalignment. A comparison was made between eyes that had a ring inserted and those that had not.
Of the 13 eyes that had no Malyugin Ring inserted, the OCT demonstrated 2 (15%) had endothelial misalignment, 4 (31%) had wound gape, and 3 (23%) had endothelial detachment. A total of 9 eyes (69%) had architectural changes noted on OCT. Of the 5 eyes in which a Malyugin Ring Introducer was placed through the wound, 1 (20%) had endothelial misalignment, 1 (20%) had wound gape, and 2 (40%) had endothelial detachment. A total of 4 eyes (80%) had architectural noted on OCT.
A Malyugin Ring is a valuable tool for management of intraoperative miosis in cataract surgery. In resident-performed cases in which a ring was utilized, there was a small increase in the rate of postoperative day 1 wound architectural changes detected by anterior segment OCT. A resident must learn to carefully pass instruments through corneal wounds, including properly deploying and retrieving a Malyugin Ring. Wound architectural changes from instrumentation used during surgery could lead to wound instability and hypotony or an increased risk of endophthalmitis.
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