Malyugin Ring 2.0 aids difficult cataracts

Prof. Boris Malyugin described the Malyugin Ring 2.0 as a tool that can help in cataract surgery when poor pupil dilation and zonular weakness appear together, according to an Ophthalmology Times Europe article published on February 21, 2022. The piece said the device can be used not only to enlarge a small pupil but, in selected cases, to help stabilize the capsular bag during surgery. A related Ophthalmology Times article carried the same case-based message and identified the device maker as MicroSurgical Technology. (europe.ophthalmologytimes.com) The report focused on a problem cataract surgeons know well: small pupils and compromised zonules often show up in the same eye, especially in pseudoexfoliation and other difficult anterior-segment cases. (europe.ophthalmologytimes.com) Malyugin wrote that those cases can become harder when the surgeon must solve one problem while the other remains unstable. His article framed the ring as one option that can sometimes address both issues at once. ### Why are small pupils and weak zonules such a difficult combination? Poor mydriasis limits visualization during cataract surgery, and Ophthalmology Times Europe said inadequate dilation can raise the risk of iris damage, bleeding, prolapse, capsule trauma and intraoperative complications. (europe.ophthalmologytimes.com) Zonular weakness creates a separate problem by making the lens-bag complex less stable during capsulorhexis and lens removal. When both are present, the margin for error narrows. Pseudoexfoliation was among the conditions named in related coverage of the Malyugin Ring 2.0 as a cause of inadequate dilation, alongside chronic uveitis, glaucoma, diabetes mellitus, intraoperative floppy iris syndrome and idiopathic cases in older patients. (europe.ophthalmologytimes.com) That overlap helps explain why surgeons look for a device strategy before entering the operating room. ### What did Malyugin say the ring can do in these eyes? Malyugin wrote that he had come to rely on the Malyugin Ring together with MST capsule retractors, Chang modification, in eyes with inadequate mydriasis and compromised zonules. He said the retractors are useful for overcoming zonular weakness and supporting the equator of the capsular bag. (europe.ophthalmologytimes.com) He added that, in some cases, the ring itself can be used to “simultaneously address the small pupil and stabilise the capsular bag.” The 2.0 version was described elsewhere by Ophthalmology Times Europe as having more space between the anterior and posterior scrolls than the classic version, a design change intended to make iris engagement and disengagement easier. (europe.ophthalmologytimes.com) Labtician Ophthalmics, a distributor page for the product, described the same feature and said the ring fits through a 2.0-mm or larger main incision without additional paracenteses. ### How does this compare with other ways to manage a small pupil? Ophthalmology Times Europe listed several alternatives for small-pupil management, including iris cutting, mechanical stretching, iris hooks, heavy viscoelastic use and pharmacologic dilation. (europe.ophthalmologytimes.com) Pascal Rozot, writing in 2020, said he viewed the Malyugin Ring 2.0 as one of the better tools for maintaining dilation through the case and reducing extra steps in difficult cataracts. Malyugin did not present the ring as a universal replacement for capsule retractors. Instead, his article said the ring may work alone in some eyes, while other cases still call for the ring in combination with retractors for added capsular support. (europe.ophthalmologytimes.com) ### What is the practical takeaway for surgeons planning these cases? The Ophthalmology Times and Ophthalmology Times Europe pieces both pointed to preoperative planning rather than intraoperative improvisation. Malyugin wrote that instrument choice in small-pupil cataract surgery should be based on iris characteristics, including stromal floppiness, stiffness and sphincter fibrosis. (europe.ophthalmologytimes.com) In the case he described, loose zonules and lens mobility during capsulorhexis drove the decision to use the Malyugin Ring 2.0. The article remains available on Ophthalmology Times Europe, and the parallel Ophthalmology Times version identifies Boris Malyugin, MD, PhD, and the named instruments used in the case. (europe.ophthalmologytimes.com) (ophthalmologytimes.com)