In our phaco fundamentals series, we have explained the basics of choosing fluidic parameters for the phaco machines. These settings are important in order to provide a safe and stable chamber for phaco surgery. In cases of floppy iris syndrome, we can alter these fluidic settings to assist in surgery.
By increasing the infusion pressure (either by direct programming of estimated anterior chamber pressure or via bottle height to increase gravitational forces), we can push the floppy iris back towards the iris root. This will give more dilation during surgery and will limit the prolapse of the iris tissue.
This case is a good example of that principal. By increasing the infusion pressure by 50%, we are able to widely dilate the pupil — going from 4 mm in diameter to 6.5 mm in diameter just by this technique. This is more than double the pupil area and it allows better access to the capsular bag while keeping the iris at bay.
Click below to learn how the infusion pressure can influence the pupil dilation: