In Manual Small Incision Cataract Surgery (MSICS), iris prolapse usually stems from a pressure gradient where fluid trapped behind the iris pushes it through the tunnel. To manage this, the most effective first step is to equalize the pressure. Avoid the urge to push the iris back directly, as this can cause tissue trauma or iris memory. Instead, release fluid from a paracentesis to lower the intra-ocular pressure. Once the chamber is soft, gently tapping the external roof of the scleral tunnel can often coax the iris back into position without direct contact. If it remains stubborn, you can use a sweep or micro-forceps through a side port to pull the iris centrally. For recurrent prolapse, check your tunnel architecture for premature entry; you may need to suture the leaking wound or use a cohesive viscoelastic to tamponade the iris root before continuing.
Close the wound and go to another location to create a new tunnel with greater width.You will have lesser ifis trauma.