The B-HEX® Pupil Expander is a globally patented and trademarked 3rd generation ‘Bhattacharjee ring’ which uses a radically different inventive concept. It is a uniplanar thin flexible hexagonal device with notches at the corners and flanges at the sides. Alternate flanges are tucked under the iris to engage the notches to the pupil margin and provide pupil expansion. The single use disposable 6.5 mm device provides a 5.5 mm expanded pupil which is adequate for phaco surgery and IOL implantation. It is preloaded in an innovative transparent housing with a handle which presents the sterile device at the incision. The surgeon effortlessly slides the device into the anterior chamber using the ‘B-HEX® 23 G Forceps’.
It is heartening to note that all surgeons who have used the B-HEX Pupil Expander are convinced that an Injector is unnecessary and that other devices use an Injector only to circumvent inherent flaws in their design. Injectors neither improve the functionality nor enhance sterility of the pupil expansion device.
An Inventor always poses questions in an attempt to find better solutions.
Existing devices had large biplanar scrolls/ pockets which snagged the slit corneal incision on their way in and out. It appeared fundamentally wrong to try and push this biplanar structure through a slit corneal incision – it would obviously snag the incision. This was resolved by inventing a planar/ uniplanar ‘B-HEX Pupil Expander’ which could effortlessly glide in and out of the eye through very small incisions. Please see detailed description and drawings below.
It was realized that the Injector had been provided only to circumvent the problem of snagging at the incision. Hence, a device that did not snag the incision would not require an injector.
No, it does not.
When an Injector is used to deliver an IOL, it helps fold the large stiff IOL to negotiate it through a
small incision. This is necessary because otherwise, significant force and additional maneuvers are
required to accomplish this. But, Pupil expanders do not require such force or maneuvers to be
folded/ deformed to negotiate through corneal incisions. They are resiliently flexible and can easily
deform and regain shape as they pass through small incisions.
Since the flanges of the ‘B-HEX Pupil Expander’ are held and tucked with the ‘B-HEX 23 G forceps’, the control is at the site of action. This is in contrast to a device delivered with an injector where the control is more remote and away from the site of action.
Another advantage of not using an Injector system with an opaque metal tube is that the B-HEX is never obscured and is visible through its entire travel from the housing into the eye.
The Injector does not provide enhanced sterility because the tube/ cartridge nozzle contacts the conjunctiva as it negotiates the incision. While the IOL or the pupil expander may not contact the incision or conjunctiva, the injector tube or cartridge nozzle does so when it enters the eye. So does the phaco sleeve and every other instrument that we use in ocular surgery.
All other pupil expanders have scrolls, channels or pockets which make the pupil engaging part a thick biplanar structure. This is difficult to pass through a slit corneal incision and causes snagging. Hence all these devices require an Injector for delivery and removal. The B-HEX on the other hand has a thin profile and uniplanar design that allows it to glide through much smaller incisions without an Injector. The B-HEX® takes advantage of the fact that the Iris can be reversibly bent without harm.
This is a self-learning group of persons interested in the B-HEX Pupil Expander. By sharing pearls and pitfalls we learn from and teach each other how we could use this innovative device better. Experienced users are readily available for hand-holding and guiding new users. Learning is a continuous process ...........