Phacoemulsification with Malyugin ring in an eye with persistent pupillary membrane--case report

During fetal development the lens receives nourishment through a vascular net called "tunica vasculosa lentis" which forms the pupillary membrane on its anterior surface and may cause iris deformation. Nowadays, even more attention is paid to the safety of surgical procedures. Phacoemulsification in eyes with a narrow pupil, which doesn't respond to standard mydriatic agents applied preoperatively, is a challenge for any ophthalmic surgeon. Recently, a new device for intraoperative pupillary stretching has been described--the Malyugin ring. We describe a patient with persistent pupillary membrane succesfully operated for hard cataract using standard phacoemulsification with Malyugin ring. The purpose of using Malyugin ring in this case was to avoid intraoperative bleeding caused by cutting blood vessels that might have been present within the pupillary membrane, to secure a wide and stable pupil, to avoid accidental aspiration of the membrane, to postpone the moment of cutting the membrane until the end of the procedure and in this way to increase overall safety of the procedure. The case indicates that Malyugin ring is a good tool which used intraoperatively may assist the surgeon in cataract extraction in eyes with persistent pupillary membrane of unknown blood vessel content.