Pros & Cons of Iris Hooks in Cataract Surgery
•Iris hooks are excellent for expanding small pupils in cataract surgery
•Begin by marking the 4 incision sites for the hooks in a diamond configuration
•After making small incisions using a paracentesis blade, uses the hooks without viscoelastic to lyse the posterior synechiae or iris, providing exposure a
•To remove the hooks, simply rotate it clear of the iris and pull it out
PROS:
•Enhanced View: Significantly improves the surgeon's view in small pupils, crucial for safety and effective lens removal
•Customizable Control: Allows for variable, titratable pupil expansion, unlike rings, by adjusting tension
•Versatile: Works well for various challenging situations, including diabetic eyes, vitrectomized eyes, and specific iris conditions like iridoschisis
•Easy to use: Makes difficult cases manageable, even for junior surgeons, transforming complex procedures
•Space-Saving: Doesn't add bulk in shallow AC, unlike some rings
CONS:
•More Incisions: Requires additional tiny incisions (paracenteses) for each hook, increasing surgical steps
•Surgical Time: Can add minutes to the overall operating time compared to pupil rings
•Risk of Iris trauma: Potential for small tears, pigment release, or holes in the iris tissue.
•Post-Op issues: May cause minor pupil distortion or temporary inflammation
•Less optimal than other devices: In cases of significant zonular weakness, capsule support hooks might be safer, though hooks are a good alternative
•Iris hooks are a valuable tool for achieving safe, effective pupil expansion in complex cataract surgeries, but surgeons must balance their benefits against the need for extra steps and potential for minor iris-related complications, especially with careful technique and patient counseling
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Image from Rajan Eye Care Hospital
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