Dr. Bhattacharjee has a pending international patent application (PCT-WIPO) for the pupil-expansion devices.

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.

We describe an ab externo technique for scleral fixation of a subluxated single piece AcrySof (Alcon, Texas, USA) intraocular lens (IOL). A 10-0 polypropylene transcleral suture brought out of a paracentesis and traced back to form a loop is used to tie a cow hitch knot around a temporarily externalised haptic. The one piece design of the IOL, with flexible haptics, allows temporary externalisation through a 1.2 mm paracentesis. The tacky nature of the haptic material, square edges and the knob at the tip prevent slippage of the knot. The advantage of this technique is that the same one piece AcrySof IOL is retained and secured, while the risks and manipulations associated with explantation and exchange are avoided. While mere sulcus placement of a single piece AcrySof IOL may be associated with complications, scleral fixation is a viable solution.

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