For a beginning surgeon it is helpful to see surgeons performing techniques that are out of your comfort zone. The goal is not necessarily to emulate these cases, but rather to learn techniques that can be incorporated into your own style. In a case like this with a small pupil, Flomax (tamsulosin) use causing intra-operative floppy iris syndrome (IFIS), and pseudo-exfoliation (PXF), many surgeons would opt to use iris hooks or a pupil expansion ring.

For Dr. Dobrin Boyadzhiev from Bulgaria, this is not needed. Instead, the pupil is expanded with pupil stretching and the phaco is performed through a small opening in the iris. Care must be taken to avoid touching and damaging the iris and we must also ensure that no cataract material is left in the capsular bag. I have encouraged a technique of lifting the iris with the chopper to accomplish this.

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