Use of four-leaf clover-shaped pupil expansion device in intraoperative floppy-iris syndrome

The reusable clover-shaped pupil expansion device (Clover ring) was used during cataract surgery in 31 eyes of 19 patients with intraoperative floppy-iris syndrome (IFIS). Mean implantation and removal times were 56.2 ± 16.0 seconds and 19.2 ± 4.7 seconds, respectively. All rings remained intact after removal and could be reused. No intraoperative complications, including iris damage, iridodialysis, or hyphema, were observed. Iris prolapse did not occur when the ring was correctly positioned. Once engaged, the device was stable, and unintentional dislodgement was not noted. Postoperatively, no sphincter tears, iris distortion, atrophy, or permanent mydriasis occurred. At 1 month, pupil diameter averaged 1.9 ± 0.3 mm with normal pupil reactivity. No cases of prolonged iridocyclitis, cystoid macular edema, or intraocular pressure elevation were detected. The Clover ring provided a safe and stable method for managing IFIS during cataract surgery. The ring remained stable intraoperatively and lowered a cost burden because of its reusability.