Simultaneous pupil expansion and displacement for femtosecond laser-assisted cataract surgery in patients with lens ectopia

We describe a new approach for cataract surgery in ectopia lentis associated with an inadequately dilated pupil. A Malyugin ring 2.0 is first positioned in the eye to expand the pupil. One of the ring coils is then temporarily sutured to the limbal area with 10-0 polypropylene. With this maneuver, the pupillary expansion ring is placed in alignment with the center of the ectopic lens. Femtosecond laser anterior capsulotomy and lens fragmentation is then performed. Next, the temporary suture is released, a capsular hook(s) is placed to support the lens, and the lens is emulsified. A modified capsular tension ring is then inserted and sutured to the ciliary sulcus to center the capsular bag and the intraocular lens is implanted. This new technique for patients with insufficiently dilated pupils associated with ectopia lentis has the potential to improve surgical results and minimize complications in selected cases.