Eyeworld

I MY WORST COMPLICATION N FOCUS 58 | EYEWORLD | OCTOBER 2020 by Liz Hillman Editorial Co-Director viscoelastic device, and/or too much pressure can contribute to cases of iris prolapse or trauma. 'This is a skill to practice' It was 2010 and Thomas Oetting, MD, was supervising his chief resident at the time on a cataract case. The patient was on tamsulosin. "This is an example of bad things aligning to cause a problem," Dr. Oetting said of the case. They had used intracameral epinephrine to keep the pupil, for the most part, large enough to create the capsulorhexis and allow for lens removal without hooks or rings, he said. "However, just with the last piece of nuclear material, the patient moved a bit as the surgeon came more anterior to get a piece in the subincisional area and bam! As the piece was removed, the tip caught the iris and caused significant damage," Dr. Oetting said. The surgeon was able to remove the remaining cortical material and place the IOL without further damage, followed by two sliding Siepser, 10-0 Prolene sutures with a CTC6L needle to close the defect. "This is a skill to practice before something like this happens, and I would suggest using artificial eyes," Dr. Oetting said, citing Phillips Studio eyes, Bioniko, Kitaro (Frontier Vision), and SimulEYE (InsEYEt) as options. "It's very important to be prepared to be able suture the iris," he said. "Rarely used skills like this can so easily be practiced now with the excellent simulated eyes we have in our own ORs (as there is no cadaver or animal products), using our own instruments without any special wet lab." The patient did well postop with a little glare but otherwise "excellent return of visual function," Dr. Oetting said. 'Time and again, the iris comes into the phaco tip' Manish Mahendra, MD, described in a 2019 ASCRS Annual Meeting video how iris prolapse occurred during hydrodissection on a patient I ris prolapse into phaco and/or sideport incisions or trauma from it getting caught in the phaco needle is a complication that is most commonly associated with in- traoperative floppy iris syndrome (IFIS). Intraoperatively, too small or too wide of an incision, use of too much ophthalmic Unruly iris during cataract surgery This intraoperative photo shows mild iris prolapse into the incision before all of the cortex was removed. Iris prolapse occurred during an IOL exchange. Kevin Miller, MD, said he was just getting ready to remove a Malyugin ring at the point captured in this image. You can see mild iris atrophy in addition to prolapse. Source (all): Kevin Miller, MD

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