Management of Intraoperative Prolapse during Cataract Surgery

Abstract

Purpose (max 100 words): There are few events more frustrating to a young cataract surgeon than intraoperative iris prolapse during cataract surgery. The iris is a mobile kinetic structure that is easily affected by pressure gradients. Therefore, intraoperative iris prolapse is almost always due to high pressure behind the iris and low pressure in front of it. The aim of this educational video is to highlight methods to prevent intraoperative iris prolapse and describe techniques to proceed with cataract surgery in the event that it happens. Setting/Venue (The name of the hospital or the university where the research took place.) (max 50 words): Lo Fong Siu Po Eye Centre, Grantham Hospital Department of Ophthalmology, University of Hong Kong, Hong Kong SAR Methods (max 100 words): It is important to identify at-risk eyes prior to cataract surgery during preoperative assessment, including eyes with short axial length and/or atonic pupils. For such eyes, prophylactic measures early in surgery including adjusting incision site, tunnel length and the use of intracameral 2.5% phenylephrine solution can greatly reduce the risk of intraoperative iris prolapse. In the event that intraoperative iris prolapse occurs, techniques are described to balance the pressure gradient on the iris while continuing with cataract surgery. At the end of surgery, incision wounds are sutured to maintain pressure balance. Results (max 100 words): Iris prolapse during surgery can result in a more difficult procedure with worse visual outcomes. Patients will be at increased risk to ocular pain and bleeding, and there is risk of permanent iris damage/atrophy, causing glare. Identifying at-risk patients, modifications in surgical techniques can greatly reduce the risk of iris prolapse. However, knowledge of the reasons for iris prolapse can greatly facilitate continuation of cataract surgery and prevention/minimization of further iris damage. It is important to suture incision wounds at the end of surgery, with special care to avoid suturing prolapsed and floppy the iris to the wound. Conclusions (max 100 words): Intraoperative iris prolapse can be a difficult experience. This educational video highlights methods to minimize this in at-risk eyes and describes methods to proceed with surgery in the event that it occurs. Despite increased difficulty, patients can still achieve excellent visual outcomes.