IRIS PROLAPSE DURING CATARACT SURGERY

To describe appropriate actions at the time of iris prolapse in cataract surgery.

Eye Surgery Centre Pfeifer

During cataract surgery, in case of iris prolapses different manoeuvres were performed to reposition the iris. If the pressure in anterior chamber is high, the iris cannot be repositioned. If the chamber is deep, the viscoelastic or BSS can be aspirated through paracentesis before repositioning iris using viscoelastic. When the anterior chamber was shallow, a 25-gauge or 27-gauge trocar and vitrectomy handpiece were used to perform vitreous tap 4 mm behind the limbus, or an incision, using a 25-gauge MVR blade 4 mm behind the limbus through pars plana, was then performed. At the time when the pressure has been successfully lowered the reposition of iris using viscoelastic was performed.

Using previously described techniques all iris prolapses were repositioned successfully. No serious iris damage occurred in our cohort of patients.

After this procedure phacoemulsification could be performed safely.  If the iris is floppy at the side of incision and continuing phacoemulsification from this side would be difficult (i.e., resulting in iris touch or tendency for prolapse), a new incision should be performed ≥90º away. Phacoemulsification is performed through this new incision. If first incision is not watertight, it should be sutured before continuing with phacoemulsification.