Intraoperative floppy-iris syndrome: Role of the bimanual approach

Abstract

9. Applegate RA, Thibos LN, Twa MD, Sarver EJ. Importance of fixation, pupil center, and reference axis in ocular wavefront sensing, videokeratography, and retinal image quality. J Cataract Refract Surg 2009; 35:139-152 10. Packer M, Fine IH, Hoffman RS. Aspheric intraocular lens selection based on corneal wavefront. J Refract Surg 2009; 25:12-20

Management of intraoperative iris prolapse: Stepwise practical approach

“…In addition to the specific pharmacological and mechanical strategies discussed, the surgeon can alter his/her surgical technique to prevent initial or recurrent iris prolapse. The surgical maneuvers that pose the highest risk for iris prolapse include hydrodissection ( Figure 8, A), 5,6 coaxial I/A, 49 and intraocular lens insertion using forceps (Figure 8, B). 50 During hydrodissection, it is important to ensure that the anterior chamber is not overfilled with OVD.…”

“…8 Because iris prolapse is the result of pressure changes and fluid egress from within the eye, attempts should be made to perform surgery under low aspiration flow and vacuum settings. 5,49 This is particularly important when OVD has been used as a barrier to further prolapse and care must be taken not to wash out the OVD. Occasionally, prolapse may occur through the side port during phacoemulsification; again, this is due to fluid egress from the anterior chamber resulting from an oversized side port.…”

“…This may be avoided by the use of a bimanual I/A or a manual coaxial system such as the Simcoe cannula. 49 Both the bimanual and manual coaxial I/A cannulas can be adequately introduced into the anterior chamber through an appropriately sized paracentesis and avoids using the main wound. It is, however, important to avoid undersizing the paracentesis as this can result in wound stretching with resultant leaking.…”

Comparing the efficacy of mydriatic cocktail-soaked sponge and conventional pupil dilation in patients using tamsulosin – a randomized controlled trial

“…Various strategies were advocated for patients taking α1-ARA to achieve appropriate mydriasis and to overcome the progressive miosis such as: preoperative topical atropine, intracameral injection of epinephrine, careful wound construction, mechanical pupil dilation, gentle hydrodissection, low-flow fluidic settings, and bimanual irrigation-aspiration [15-17]. …”

“…Preoperative discontinuation of α 1 adrenergic receptor antagonist medication has an unclear role in inhibiting the occurernce of IFIS [2,5,12,17-20]. …”