Management of common iatrogenic iris defects induced by cataract surgery

Abstract

The proximity of the iris to the instruments and currents of cataract surgery makes iatrogenic damage to the iris a common complication of cataract surgery. This article discusses techniques to prevent or minimize this damage. When damage does occur, the surgeon must decide if, when, and how to repair the damage. Principles governing these decisions and techniques for repair are discussed. Figures and videos, included as online Supplemental Data files, illustrate cases of iatrogenic damage and repair techniques.

Three-Month Safety and Efficacy Outcomes for the Smaller-Incision New-Generation Implantable Miniature Telescope (SING IMT™)

“…A sizeable number of AEs and complications were associated with the iris, likely due to the degree of iris manipulation that was needed to correctly position the device. Indeed, iatrogenic iris defects are also a common complication of cataract surgery [ 24 ]. Techniques to prevent and minimize this damage with the SING IMT™ will improve with additional experience with implanting the device.…”

Cataract in the Adult Eye Preferred Practice Pattern®

“…Iridodialysis involves disinsertion of the iris from the internal wall of the eye. 745 Damage to the iris can result from iris prolapse due to conditions such as intraoperative floppy iris syndrome (IFIS) 746,747 or a poorly constructed incision. Causes of surgical iris trauma due to a shallow chamber may include iris aspiration or agitation from the phacoemulsification tip, sphincterotomies, and excessive stretching or manipulation from expansion devices (iris hooks and rings) and instruments.…”

“…The sequelae of such trauma may include iridodialysis; hyphema; transillumination defects; traumatic mydriasis; and an irregular, atonic, or misshapen pupil. 745 Sphincter necrosis may occur perioperatively as a result of endophthalmitis, TASS, or excessively increased IOP that may result in a chronically dilated or irregular pupil.…”

“…1042,1043 Patients should be offered surgical repair of symptomatic iris defects caused by cataract surgery. 1044 Intraoperative floppy iris syndrome is a unique small-pupil syndrome associated with iris billowing and prolapse as well as with progressive intraoperative miosis. 1026,1045 It is associated with a higher rate of surgical complications, particularly when it is not recognized or anticipated.…”

Comment on: Management of common iatrogenic iris defects induced by cataract surgery

“…Naeser first described a vector method for looking at the change aligned along the intended meridian of correction and, more recently, expanded this to simplify surgically induced astigmatism in both corneal incisional and intraocular lens-based surgery. 1,2 This corresponds to the with-thewound/against-the-wound approach we used. Our study also looked at the net astigmatic change, comparing preoperative corneal astigmatism with postoperative refractive astigmatism.…”