The iris/pupil can hold the nucleus during phaco

Today we have an unedited video of a routine case in a patient with floppy iris syndrome due to Flomax (tamsulosin) use. It is helpful to see the entire surgery from start to finish to understand all of the steps and the nuances.

The keys to surgery in this situation are:

  • Make the capsulorhexis under the iris so that it has a larger diameter than the pupil. We want a 5 to 5.5 mm diameter capsulorhexis, not smaller.
  • Gently perform hydro-dissection to bring the nucleus out of the capsular bag. This is a slow and steady move without excessive pressure.
  • Use the cannula to bring the nucleus further out of the capsular bag and into the iris plane so that the pupil holds it securely.
  • The nucleus can be chopped and phaco-emulsified at this point. The nucleus also keeps the floppy iris out of the way.

click below to learn from this case with an unedited video, start to finish:

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