Comparative Analysis Of B-Hex Pupil Expander Vs. Iris Hooks In Small Pupil Cataract Surgery: Surgical Efficiency And Safety

To compare the B-Hex pupil expansion ring and iris hooks in phacoemulsification for small pupils (≤4 mm post-dilatation)using special techniques, focusing on insertion/disengagement time, total phacoemulsification time, intraoperative pupil size, best-corrected visual acuity (BCVA), complications (iris trauma, capsular tears), surgeon stress (VAS 1-10), and patient-reported pain (post-op VAS). This retrospective comparative study on 50 eyes (25 per group) evaluates device efficiency and safety for cataract surgeons managing intraoperative miosis.

Advanced cataract and refractive surgery centre in Chennai, India. Single-surgeon retrospective comparative study on 50 patients (25 eyes/group) with small pupils undergoing phacoemulsification (all cataract grades including white cataract and all monofocal IOL types including toricIOL). Data was reviewed from surgical records with institution.

50 eyes with pupil size  ≤4 mm assigned to B-Hex pupil expanders (Group 1) or iris hooks (Group 2). Parameters: device insertion/disengagement time (seconds), total surgical time (minutes from incision to speculum removal), intraoperative pupil diameter (mm via calipers post-insertion), pre/post-op BCVA, complications (iris bleeding, sphincter tear, capsular tear, pigment dispersion, IOP spike), surgeon stress (intra-op VAS 1-10), and patient pain (post-op VAS 1-10). Cataract surgery was performed using phaco machine with active fluidics during phacoemulsification(ZEISS microscope, Centurion active fluidics system); statistics were compared (paired t-test, P<0.05).

B-Hex showed shorter insertion/disengagement time (mean 240±80s vs. 310±85s hooks, P=0.02), total surgical time (20.5±3.5min vs. 26±7min, P=0.01), and fewer additional incisions (0 vs. 4/group). Pupil size similar (6.2±0.4mm both, P=0.8); BCVA improved to 0.1 LogMAR both (P=0.9). Complications: B-Hex (iris bleed 1, incomplete insert 2); hooks (sphincter tear 2). Surgeon stress lower with B-Hex (3±1 vs. 6±2, P=0.03); patient pain comparable (2±1 both, P=0.7). 

B-Hex pupil expanderoffers superior efficiency with reduced insertion/disengagement and total surgical times versus iris hooks in small pupil phacoemulsification, plus lower surgeon stress—while matching pupil expansion, visual outcomes, and patient comfort. Iris hooks remain cost-effective but add procedural complexity.It is user-friendly and when right tools and techniques are employed, it simplifies small pupil cases without added incisions, making it ideal for every surgeon.