We have all experienced it: the case is going well but then the iris starts to prolapse out of the incision. How can we address this issue without damaging the delicate iris tissue?
The key is understanding the pressure gradients. When the pressure behind the iris is higher than the pressure in front of it, there will likely be iris prolapse. Other factors contribute to this such as incision construction, patient anatomy, and tamsulosin (Flomax) use.
While you could place more viscoelastic on top of the iris to increase the pressure above it, this is a temporary solution since the viscoelastic will be washed out. Using viscoelastic on top of the iris will reduce or eliminate the pressure gradient by having high pressure in front of the iris to match the high pressure behind the iris.
A better solution tends to be releasing the high pressure from behind the iris. This will then eliminate the pressure gradient since it will be low pressure behind the iris as well as in front of it.
Click below to learn this technique to easily fix iris prolapse: