The iris can prolapse any time that a pressure gradient exists in front of, and behind the iris tissue. This patient takes Flomax (tamsulosin) which is associated with IFIS: intra-operative floppy iris syndrome as shown in the landmark study by David Chang MD. At the beginning of the cataract surgery, the pupil is a reasonable size, but during the case it begins to constrict and by the second half of the procedure, there is iris prolapse and miosis. This video shows techniques to handle the iris prolapse in mild cases like this.
The key in management is to equalize the pressure gradient by releasing fluid from behind the iris. We can also put additional viscoelastic in front of the iris to help in this regard. These cases can be managed with simple intervention and this results in an efficient surgery with an excellent post operative result.
Click below to learn how to manage mild iris prolapse during cataract surgery:
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Excellent case. When do you use Miostat/Miochol or add a suture?
surgeon’s call. I don’t routinely use miotics or sutures for these cases. if the incision is leaking, then certainly I’ll place a suture. If the iris keeps prolapsing, I prefer to fix the cause of the prolapse (a pressure gradient) and then determine if a suture would help. When in doubt, place the suture!