Many of our male patients take medications to help with urinary flow such as alpha-1 antagonists, the most common of which is tamsulosin (brand name Flomax). We have learned from experience and from many published studies that these drugs are associated with Intra-Operative Floppy Iris Syndrome (IFIS) even if the patient has discontinued taking them for years.
There are many options for dealing with floppy iris such as topical atropine, intra-cameral epinephrine and phenylephrine, and even putting in iris hooks and pupil expansion devices. My preferred technique for a smaller pupil / floppy iris case is usually to use the cataract nucleus to hold the pupil open and keep the iris at bay.
We can also do cataract surgery by using the phaco chop technique with the cataract nucleus still in the capsular bag. There are ways to manage the iris prolapse and these involve equalizing the pressure gradient in front of and behind the iris. This can be by releasing the pressure posterior to the iris or by putting viscoelastic on top of the iris to balance the posterior pressure. Both techniques are shown in this video.
Click the video below to learn this technique of Phaco Chop with Floppy Iris Syndrome.
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