We have all been there to experience iris prolapse in the presence of a poorly dilating pupil, a floppy iris, and a shallow anterior chamber. This patient has a complex situation and our guest surgeon does a great job of dealing with these challenges. In addition at the end of the cataract surgery a MIGS procedure is performed to help deal with the glaucoma issues. How do you handle this type of challenge where the iris wants to prolapse even through the tiny paracentesis incision? Please comment below.
For patients with a 1.) shallow AC, 2.) dilation <5.0 mm, and 3.) on tamsulosin, I started giving pre-operative acetazolamide 500mg PO x1 to dehydrate the vitreous to allow the iris to sit back more posteriorly. So far, it has been VERY helpful in minimizing iris prolapse.
I do the same ; most shallow AC patients I give it and it’s been helpful.
great idea. thank you for the comment