B-HEX pupil expander: Pupil expansion redefined.

The B-HEX® Pupil Expander (Med Invent Devices) is a disposable 6.5 mm flexible hexagonal device with notches at corners and flanges at sides. Alternate flanges with positioning holes are tucked under the iris to engage the notches to the margin of the pupil to provide a 5.5 mm expanded pupil. Unlike devices with scrolls or pockets which require an injector to avoid snagging the incision, the preloaded B-HEX is inserted and removed through a 1 mm or larger incision using a manipulator or 23-gauge micro-forceps. The thin profile and uniplanar design allow unhindered instrument movement during phacoemulsification, cortical cleaning, and intraocular lens implantation. The B-HEX is safely used even after capsulorhexis since the thin uniplanar notches are directly visualized to avoid the capsule margin. It is useful in coaxial phacoemulsification, coaxial sub 2.00 mm micro incision cataract surgery (MICS), biaxial 1.5 mm MICS, femtosecond laser assisted cataract surgery (FLACS), small pupil pars plana vitrectomy, and shallow anterior chamber eyes.

Pupil-expansion ring implantation through a 0.9 mm incision.

UNLABELLED: Disposable square and hexagonal Bhattacharjee pupil-expansion rings are made of 5-0 nylon, have notches at the corners, and flanges at the sides in a single 0.1 mm thin plane. To insert the ring, a flange is held with a 23-gauge forceps and the ring is inserted through a 0.9 mm (20-gauge) or larger main- or side-port incision. Alternate flanges are tucked under the iris using a Kuglen hook. A 23-gauge forceps and an iris hook can also be used to tuck the flanges bimanually. The ring is removed by disengaging 2 notches and pulling it out of a 0.9 mm (20-gauge) incision. No snagging of the incision occurs at insertion or removal. No injector is required. The device is useful in standard coaxial phacoemulsification, femtosecond laser-assisted cataract surgery, biaxial microincision cataract surgery (MICS), coaxial sub-2.0 mm MICS, and small-pupil microincision vitreous surgery and in eyes with shallow anterior chambers. FINANCIAL DISCLOSURE: Dr. Bhattacharjee has a pending international patent application (PCT-WIPO) for the pupil-expansion devices.

Diabetic retinopathy: need for awareness amongst physicians.

The physician as a general practitioner, endocrinologist, nephrologist, cardiologist sees a diabetic patient first, much before the ophthalmologist, and so it is he who can help them a lot in case of diabetic retinopathy which is a highly specific vascular complication of both type 1 and type 2 diabetes. Progression of retinopathy advances step by step and ultimately loss of vision takes place. Laser photocoagulation is beneficial in preventing further vision loss. There is a need to educate diabetic patient about the devastating effects of the disease and guide them to an ophthalmologist - preferably a retina specialist.