DEC 2013

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

Issue link: https://digital.eyeworld.org/i/227001

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December 2013 elevated IOP from the irrigation will result in a large pressure gradient with rapid fluid (and iris) egress. To prevent this, simply stop the irrigation and allow the eye to soften slightly prior to removing the I/A tip (Figure 2). 2. If iris does prolapse despite softening the eye prior to I/A tip removal, the urge to push it back with a cannula should be resisted. Instead, the pressure gradient across the wound can still be lowered by tapping the paracentesis port (Figure 3). Continued lowering of the IOP stops the fluid flow through the wound, frequently retracting the iris back into the eye. 3. If the iris does not settle back in the eye with fluidics alone, gentle pressure can be used to reposition the iris by massaging the anterior lip of the wound with the cannula (Figure 4). This squeezes the iris back into the eye without touching the iris. After the iris is out of the wound, pressing the anterior lip of the wound helps to facilitate wound closure and sealing. 4. The stroma is hydrated without filling the eye and raising the IOP. By directing the irrigation cannula as tangentially to the incision as possible and by slowly injecting (Figure 5), the wound can be sealed with minimal fluid egress and no iris prolapse. Stromal edema should appear without deepening the anterior chamber. When the wound seals, it is then safe to fill the eye. The anterior chamber will deepen and the iris will move posteriorly, away from the wound. Using a combination of these four maneuvers, a case of iris prolapse can be resolved quickly and easily. It is important to remember that when lowering the IOP to subphysiologic levels (note corneal striae in Figures 2 and 3), there is a theoretical risk of suprachoroidal hemorrhaging. Therefore, it is important to address modifiable risk factors such as systemic arterial hypertension, coughing, and the duration of hypotony. In reality, these steps can be performed in a matter of seconds, helping to complete a case with negligible risk. With these simple techniques, iris prolapse can be managed with confidence instead of frustration. By managing fluidics and avoiding direct iris manipulation, trauma is minimized, and a once-frustrating complication can be resolved with a simple solution. EW Editors' note: Dr. Chang is a partner at Empire Eye and Laser Center in Bakersfield, Calif. He has no financial interests related to this article. THINK ENERGY REDUCTION "With the LENSAR Laser, I've experienced a signifcant reduction in phaco energy, and in some cases I've needed no ultrasound energy at all. More importantly, I've seen a reduction in infusion volume and surgical time, resulting in much quieter postoperative eyes." EW CATARACT 21 Contact information Chang: 661-325-3937, dchang@empireeyeandlaser.com At LENSAR™, we're always thinking ahead. That's why we designed the LENSAR Laser System with phaco energy reduction in mind. By combining superior imaging of the anterior segment, precise laser placement, and effcient lenticular fragmentation, the LENSAR Laser allows for a reduction in phaco time and up to 100% reduction in phaco energy.1 This ultimately provides patients with a higher level of safety and you with greater peace of mind. The LENSAR Laser System. Designed for energy reduction, designed for you. Learn more at LENSAR.com – Jonathan Solomon, MD Scan to hear from fellow surgeons why LENSAR is the intelligent choice for cataract surgery.

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