Cataract Surgery Quiz: For a pupil like this, what is your approach?

With time, young ophthalmologists develop surgical judgment and they are able to look at a case and decide what approach will work best in their hands. This is such a case – the patient is an 80-year-old man who takes Flomax (tamsulosin) and we know that puts him at risk for intra-operative floppy iris syndrome (IFIS as described by David Chang MD).

The pupil starts out with a reasonable size but it tends to change and fluctuate during the surgery. Would you approach this case with iris hooks? Pupil expansion rings? A pupil stretching technique? Or would you simply just complete the case without any of these? I think that you already know what my approach is going to be.

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