I
MY WORST COMPLICATION
N FOCUS
60 | EYEWORLD | OCTOBER 2020
To prevent this situation, Dr. Mahendra
said preoperatively to be aware of alpha block-
ers in the medical history and discontinue them
ahead of surgery, prescribe atropine and reduce
IOP.
"However, tamsulosin and other alpha
blockers have long half-lives and remain in the
anterior chamber as long as 28 days. Also, alpha
blockers cause ultrastructural changes in the iris
stroma leading to its functional loss even after
discontinuation of the drug," Dr. Mahendra
said.
Intraoperatively, Dr. Mahendra said a MICS
technique should be used, with a long, water-
tight main incision and sideport. Intracameral
epinephrine and viscomydriasis can be used to
maintain an adequate pupil size along with iris
hooks and pupil expanders. Exercise restraint
when hydrodissecting and carefully adjust fluid-
ics during the case, Dr. Mahendra said.
continued from page 59
This direct illumination photo shows severe temporal iris
trauma from intraoperative iris prolapse during cataract
surgery in a patient who was referred to Kevin Miller,
MD.
This higher magnification retroillumination photo of a
patient referred to Dr. Miller with severe temporal iris
trauma from intraoperative iris prolapse shows that the
edge of the optic and opacified peripheral capsule are
visible behind the iris defect. The patient had severe light
and glare sensitivity under all lighting conditions.
Source (all): Kevin Miller, MD
"It's very important to be
prepared to be able suture the
iris. Rarely used skills like this
can so easily be practiced now
with the excellent simulated eyes
we have in our own ORs, using
our own instruments without any
special wet lab."
—Thomas Oetting, MD
