Usefulness of the Malyugin ring upside-down technique

The use of the Malyugin ring involves inserting a folded ring inside an injector and then expanding and fixing the pupil with the 3 spiral fixation points. The typically recommended technique as provided by MicroSurgical Technology involves inserting the injector with the opening facing upward. However, this technique is often challenging in cases where 3-point fixation of the scrolls on the pupil with a 1-action insertion is difficult. To address these challenges, we have been using the upside-down technique, where the injector is inserted with the opening facing downward, to achieve a high success rate in 1-action 3-point fixation. This technique demonstrated a success rate of over 80% in achieving 1-action 3-point fixation. 1-action 3-point fixation tended to be easier in smaller horizontal pupils. The upside-down technique suggests the potential for achieving minimally invasive and efficient pupil expansion.