In this case, Drs. Oetting and Maassen demonstrate the use of 2 Kuglen hooks to stretch the iris in order to enlarge the pupil and proceed with phacoemulsification. Beware of the pupil stretch these days as it is exactly the wrong thing to do with patients on Flomax or other alpha blockers. However on a patient who has never been exposed to alpha blockers it is a reasonable way to proceed with a small pupil case. It works best on patients with a history of central posterior synechiae or past use of pilocarpine and works less well in patients who have small pupils from pseudoexfoliation or diabetes. You can purchase a special device like a Behler to do the stretch or you can just use Kuglen hooks as Dr. Jeff Massen and I show in this video. After the stretch use a viscous dispersive viscoelastic (eg Viscoat) to push the iris out and keep it there. During hydrodissection irrigate out some of the OVD to allow the fluid wave to leave without catching OVD adherent to the iris which can generate iris prolapse.
Additional Notes: approx 1 min 30 sec