B-Hex, an ace up the sleeve for small pupil phacoemulsification

Objective: To analyze the utility and the nuances of implanting the B-HEX® Pupil Expander (Med Invent Devices, India) at various stages in small pupil phacoemulsification. Methods: This prospective interventional case series was undertaken to assess the utility of B-Hex in small pupil phacoemulsification under topical anesthesia. Our series comprised of 50 cataract cases with small pupils of various etiologies, operated by a single surgeon at our private practice, beginning February 2018. Cataract cases with pharmacological dilation of < 4 mm underwent phacoemulsification with B-Hex implantation. It was employed at the outset or interim, whenever the need arose. Results: The B-Hex ring is extremely handy and useful in small pupil phacoemulsification. The average age of our study cohort was 62 years. In 38 cases B-Hex was employed before making a capsulorhexis. Progressive pupillary constriction during nuclear disassembly warranted the utilization of the device in 9 cases, while the remaining 3 cases had a retained epi-nuclear plate or significant cortex and the ring was placed after nucleus removal. No significant complication was noted. Postoperatively, the pupil dimensions, notably the architecture, were maintained. No significant AC reaction was noted. Intraocular pressure was not high. Conclusion: Our experience showed that B-Hex is secure and easy to use under topical anesthesia. The learning curve is shallow and the technique is precise. B-Hex is truly an ace up the sleeve.