From the Guidelines
Iridodialysis is a serious intraoperative complication during cataract surgery that requires immediate management to prevent further complications and ensure the best possible outcome for the patient's vision and quality of life. When this occurs, the first step is to recognize the defect and assess its extent. According to the American Academy of Ophthalmology's preferred practice pattern for cataract in the adult eye 1, it is essential to identify any ocular comorbidities, high-risk ocular features, or systemic issues that could impact the performance and outcomes of surgery.
Some key points to consider in managing iridodialysis include:
- Small iridodialyses (less than 2 clock hours) may not require immediate repair if they don't cause symptoms or affect pupil function.
- For larger defects, surgical repair should be performed either during the same procedure or as a secondary intervention.
- The repair typically involves suturing the detached iris back to the sclera using 10-0 polypropylene or 9-0 prolene sutures with a double-armed technique.
- Temporary viscoelastic material can be used to tamponade the defect while completing the cataract procedure.
- Postoperatively, patients should receive topical steroids and antibiotics for 1-2 weeks, along with cycloplegics to reduce inflammation and prevent synechiae formation.
Prevention strategies for iridodialysis include:
- Maintaining adequate anterior chamber depth
- Gentle instrument handling
- Proper wound construction
- Careful irrigation/aspiration techniques near the iris As stated in the preferred practice pattern for cataract in the adult eye 1, the goal of cataract surgery is to enhance patient function and improve quality of life, and managing complications like iridodialysis is crucial to achieving this goal. The key to successful management of iridodialysis is prompt recognition and appropriate intervention to minimize the risk of further complications and ensure the best possible outcome for the patient.
From the Research
Iridodialysis in Cataract Surgery
- Iridodialysis is a complication that can occur during cataract surgery, where the iris detaches from the ciliary body 2, 3.
- This complication can result in visual disturbances, photophobia, glare, monocular diplopia, or cosmetic deformity 4, 5.
Repair Techniques
- Several approaches to iridodialysis repair have been described in the literature, including the use of pre-existing wounds and common materials found in operation theaters 2.
- A novel technique called "alternate iris bypass technique" has been described, which combines iridodialysis repair with phacoemulsification and intraocular lens implantation 6.
- Iris reconstruction using autologous iris preserved in cold balanced salt solution has also been reported as a successful option for repairing total iridodialysis during cataract surgery 5.
Considerations for Repair
- The decision to repair iridodialysis depends on the size and location of the defect, as well as the patient's overall ocular health and preferences 4, 3.
- Surgeons must possess a thorough understanding of available techniques and prosthetic devices to achieve optimal outcomes in terms of both visual function and cosmetic appearance 4.