April 21, 2017 Conference
Managing the Compromised Iris, Utilizing Iris Support Systems and Surgical Repair of Iris Defects
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Dr. Helen K. Wu, Tufts Medical Center (Presenter)
Speaker Session Topic
Small pupils during cataract surgery can increase the risk of complications, including posterior capsular rupture and vitreous prolapse, iris trauma and retained lens fragments. The use of mechanical intraoperative devices to enlarge small pupils can transform a potentially challenging case into a more routine case. Preparation is particularly important in cases of potential intraoperative floppy iris syndrome, frequently seen in patients taking tamsulosin and other ?1-adrenergic receptor antagonists. Iris hooks and pupillary expansion devices both may be helpful in individual circumstances to stabilize the pupil. In cases with intraoperative iris trauma, including iridodialysis or iris stromal loss, repair of iris defects will help prevent or alleviate symptoms of glare and photophobia. Common techniques include the use of mattress sutures to reattach the iris to the sclera for iridodialysis, and imbricating sutures for the repair of iris defects. Pupillary cerclage can be used to repair a dilated atonic pupil after cataract surgery. Prosthetic iris devices, not approved by the FDA, may be the best option in the setting of larger iris defects or fragile iris tissue.