Pitfalls in Ophthalmology - Why do I get iris prolapse during my cataract surgery?

By Rob Melendez, MD, MBA

1. Wound construction. I was creating my wound too short. Why?

a. The ideal wound should be a near perfect square.

b. Poor view from corneal scar or arcus senilus.

c. Overinflating the anterior chamber with viscoelastic material and entering the anterior chamber too quickly.

d. Using a dull blade (can also create a long wound too)

e. Poor angle from a deep set socket

f. Poor view from angle of the head away from you creating a pool of fluid covering the eye. If your wound is a temporal incision for cataract surgery, rotate head towards you to facilitate drainage of fluid into the side bag.

g. Too steep in downward entry into the cornea.

2. IFIS-Intraoperative Floppy Iris Syndrome

a. Print a list of medications for your surgery coordinator and in the operating room to alert your staff to be prepared for those cases.

b. Possible Medication Associations:

i. Tamsulosin (Flomax®)
ii. Finastweide (Proscar)
iii. Terazosin (formerly Hytrin®)
iv. Doxazosin (Cardura®)
v. Alfuzosin (Uroxatral®)
vi. Silodosin (Rapaflo®)
vii. Prazosin (Minipress)
viii. Silodosin (Rapaflo)
ix. Phenoxybenzamine
x. Phentolamine (Regitine)
xi. Dutasterise (Avodart)
xii. Saw Palmetto

c. How to Manage a floppy iris-Course at the Academy:

Course 212
IFIS - Pearls for Management and Prevention
David Chang, MD Sunday, October 25, 2009 2:00 PM - 3:00 PM