From the Guidelines
Iris prolapse through the wound is a serious early postoperative complication of cataract surgery that requires immediate surgical intervention, and the patient should be returned to the operating room promptly for wound revision and iris repositioning, as supported by the most recent guidelines 1. The management of iris prolapse involves careful examination of the wound, repositioning of the prolapsed iris tissue using a blunt instrument, and secure closure of the wound with sutures. Following repair, intensive topical antibiotics, such as moxifloxacin 0.5% or fortified antibiotics, should be administered every 2-4 hours, along with topical steroids, like prednisolone acetate 1% four times daily, to reduce inflammation, and cycloplegics, such as atropine 1% twice daily, to prevent pupillary movement and reduce pain 1. Some key points to consider in the management of iris prolapse include:
- Prompt recognition and treatment of the complication to prevent further damage and reduce the risk of endophthalmitis, chronic inflammation, irregular pupil, and poor visual outcomes.
- Creation of properly constructed wounds with appropriate architecture and ensuring adequate wound closure at the end of surgery to prevent iris prolapse.
- Avoiding postoperative activities that increase intraocular pressure, such as heavy lifting, bending, or eye rubbing, for at least two weeks after surgery.
- Postoperative follow-up is crucial, and patients with low-risk surgeries and no signs or symptoms of possible complications should be seen within the first 48 hours of surgery, while functionally monocular patients and those at high risk of early postoperative complications should be seen within the first 24 hours of surgery 1.
From the Research
Iris Prolapse Through Wound in Cataract Surgery
- Iris prolapse is a complication that can occur after cataract surgery, with an incidence of 2.06% in one study 2.
- The condition is more common in Asian patients and when less experienced surgeons are operating 2.
- Iris prolapse can be caused by raised intraocular pressure in association with poor wound construction or closure, and can be precipitated by post-operative coughing 2.
- Certain medical conditions, such as obstructive airways disease, can increase the risk of iris prolapse 2.
Predisposing Factors
- Previous hematologic disorder has been identified as a predictor of wound complications, including iris prolapse, in one study 3.
- The use of certain medications, such as tamsulosin, can increase the risk of intraoperative floppy-iris syndrome, which can lead to iris prolapse 4.
- Iris configuration, anterior chamber depth, and position and architecture of the corneal tunnel can also contribute to the risk of iris prolapse 5.
Prevention and Management
- Strategies for preventing iris prolapse include the use of pharmacological agents, ophthalmic viscosurgical devices, and iris retractors 5.
- Alteration and adaptation of the surgeon's technique can also help to prevent iris prolapse 5.
- In cases where iris prolapse does occur, a stepwise practical approach can be used to manage the condition 5.
- Preoperative administration of atropine can effectively prevent the occurrence of intraoperative floppy-iris syndrome in patients receiving tamsulosin 4.