Phacoemulsification with Malyugin ring in an eye with iridoschisis, narrow pupil, anterior and posterior synechiae: case report

Purpose: Iridoschisis is a rare, bilateral condition, found in the elderly and connected with the coexistence of closed-angle glaucoma. Stromal atrophy or separation of the anterior from the posterior laminae with coexisting posterior synechiae are present. Phacoemulsification in eyes with a narrow pupil, unresponsive to preoperative pharmacologic mydriasis, is challenging. Methods: In the presented case of iridoschisis with anterior and posterior synechiae, 2 ophthalmic viscosurgical devices were used and balanced salt solution was used as the infusion fluid. The Malyugin ring was used to widen and stabilize the pupil, synechiae were removed, and burst mode of phacoemulsification and "divide and conquer" technique of dividing the nucleus were used. Results: We present a case of iridoschisis with anterior and posterior synechiae, which was successfully operated for cataract using standard phacoemulsification with Malyugin ring. Conclusions: The case suggests that Malyugin ring is an effective intraoperative tool, which may assist the surgeon in cases of cataract with iridoschisis and both anterior and posterior synechiae.