From the Research
Iris prolapse through a surgical wound is an urgent postoperative complication requiring immediate intervention, and the initial management involves gentle repositioning of the iris using a sterile iris spatula or cannula after administering topical anesthesia (proparacaine 0.5% or tetracaine 0.5%) 1. The management of iris prolapse should prioritize preventing infection and controlling inflammation.
- Administer topical antibiotics such as moxifloxacin 0.5% or gatifloxacin 0.3% four times daily for 1-2 weeks to prevent infection,
- along with prednisolone acetate 1% every 2 hours initially, then tapered over 2-4 weeks to control inflammation, as shown in a study comparing the efficacy and tolerability of a fixed combination of gatifloxacin and prednisolone acetate for topical prophylaxis and control of inflammation in phacoemulsification 2.
- Cycloplegics like atropine 1% twice daily for 1-2 weeks help reduce pain and prevent synechiae formation. If the iris tissue is necrotic or the prolapse cannot be repositioned, partial iridectomy may be necessary. Closely monitor intraocular pressure as both hypotony and elevated pressure can occur. Iris prolapse typically results from inadequate wound closure, excessive manipulation during surgery, or increased intraocular pressure postoperatively, as identified in a study reviewing the incidence of iris prolapse following cataract surgery 3. Prompt treatment is essential to prevent endophthalmitis, chronic inflammation, irregular pupil, and compromised visual outcomes. It is also crucial to note that iris prolapse is less common following phacoemulsification, but all scleral sections that are extended should be sutured to prevent this complication, as concluded in a study comparing iris prolapse occurring following extracapsular cataract extraction and phacoemulsification 4.