Patients with small pupils who need to implant toric lenses, it is important to have a low threshold to use a pupillary expansion device, especially to see the marks for alignment. Visualization and alignment are by far the most difficult issues when placing a toric lens in a patient with small pupils. One potential problem is the removal of the viscosurgical device (OVD) from the bag. Sometimes the lens needs to be pushed aside and that may result in the lens spinning.
The lens position should be checked, OVD removed, and then rechecked again. Centration is not a considerable factor as long as the capsule is intact. The IOL itself will still work from an optic perspective whether the pupil is widely opened, whether it’s fixed at a particular diameter, or whether it’s completely normal, she said, but cautioned that managing patient expectations is essential. After implanting a toric…
