Flexible nylon iris retractors are a useful adjunct to cataract surgery in cases of small pupil. We present a modification of the standard technique. Instead of approaching the square-shaped pupil formed by iris retractors from the side, we recommend an approach anterior to 1 of the retractor hooks. From the surgeon's viewpoint, the pupil goes from a square shape to a diamond shape. This modification minimizes the likelihood of iris prolapse and iris damage during phacoemulsification and increases the workspace for the phacoemulsification needle.
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Oetting et al. (2002) studied this question.
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