Sitting down with… Dr. Muttuvelu

Danson V. Muttuvelu, MD, FEBO

Dr. Muttuvelu is the Chair of the Danish Cataract and Refractive Society, past Chair of the Society of the Young Ophthalmologist (FAYO) in Denmark, and a co-founder of an e-health eye-care solution in Denmark.

What originally drew you to the field of ophthalmology?

With family and roots in India, I experienced the huge impact of unnecessary blindness — cataract is a leading cause of blindness, and I wanted to make a difference in this area.

What do you see as the main challenge that ophthalmologists face today?

There have been major changes in terms of IT — the fourth industrial revolution, along with AI, IoT, automatization, VR is going to have a huge influence and we need to be prepared as ophthalmologists.

What types of cases do you deal with in your practice, and how many surgeries do you perform annually?

I do all kinds of lens surgeries and I am quite interested in the complex cases, which often arise with trainees in cataract surgery.

Zonulopathy, IFIS, or pupillary dilation — which do you see as more challenging for resident ophthalmologists and why?

Pupil-related dilation per se is challenging for residents. Zonulapathy can be very tricky due to the risk of vitreous loss and further complications. In both situations, the use of assisting tools can make surgery safer and inspire confidence when dealing with intraoperative complexities.

What are some of your tips for intra-operative management of zonulopathy?

As we know, zonulopathy can be caused by many conditions, such as pseudoexfoliation syndrome, traumatic zonulysis, Marfan syndrome, and many others. There are various approaches to dealing with zonular weakness. In the early days, capsular hooks were often used. However, the hooks are not optimized for the delicate capsule bag. Nowadays, we can rely on specialty capsule retractors (MST Capsule Retractors), which are designed to minimise the risk of a capsular tear and provide a broad point of contact with the capsule. An alternative approach is to use a capsular tension ring from the get-go, but I prefer stabilising the compromised zonules with capsule retractors before proceeding with the capsular tension ring, should I need to use it.

Did you miss our webinar with Dr. Muttuvelu? Watch it now on-demand — Dr. Muttuvelu walks us through his approach to zonulopathy in four of his recent cases.

How do you approach a small pupil and IFIS intra-operatively?

Good visualisation is essential to making every ophthalmic surgery safe and effective. Small pupil and IFIS management, therefore, play a huge role in minimising or avoiding surgical complications. My preferred approach is to use the Malyugin Ring, which has been in my tool kit for a few years now.

Why the Malyugin Ring?

Very simply, it is safe, fast, and efficient. That is what you want from a device in a high-volume cataract surgery setting. It has been consistent, reliable, and it has allowed for improved efficiency in the operating room.

Check out Dr. Muttuvelu’s article on his experience with the Malyugin Ring 2.0

What advice do you have for the next generation of ophthalmologists currently in training?

Always aim for the best possible surgery for each of your patients and grow a culture based on learning, understanding, and sharing knowledge and skills.