We have covered this lesson before, but it certainly is worth repeating: always check under the iris when you perform cataract surgery in an eye with a smaller pupil. This case surprised me because I thought that the cortex removal was complete. When I lifted the iris to check, I found a large piece of lens cortex which would have induced a lot of inflammation. Also keep in mind that retained lens cortex will swell and become much bigger and then present itself at the pupil within a day or two.
The next time that you are doing a small pupil case, use this technique to check under the iris while the eye is still full of viscoelastic.
Click below to see if you can tell that residual cortex is hiding:
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