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Equalizing pressure is key to managing prolapsed iris
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NEW YORK — Balancing the anterior and posterior chamber pressures is the best approach to managing patients with prolapsed irides, according to a surgeon here.
"Pushing the iris back in is not the answer. Fixing the pressure gradient is the only way to fix an iris prolapse," Uday Devgan, MD, FACS, said during a presentation at the OSN New York Symposium.
Iris prolapse is typically caused by high pressure posterior to the iris or low pressure anteriorly, Dr. Devgan said.
"The management is to equalize [the pressures] so the iris will return to the anterior chamber," he said.
Dr. Devgan discussed his technique for equalizing the pressure anterior and posterior to the iris to prevent or manage prolapse during cataract surgery.
When the nucleus prolapses anteriorly and forces the iris out of the wound, he suggested rocking the nucleus to release balanced salt solution that may have become trapped behind the cataractous lens.
In prolapse due to intraoperative floppy iris syndrome, Dr. Devgan recommended controlling the pressure above the iris during phacoemulsification by creating a "plug" of high-viscosity viscoelastic, such as Healon 5 (sodium hyaluronate, Advanced Medical Optics), to depress the iris. He also recommended releasing viscoelastic from behind the iris to equalize pressure an prevent prolapse toward the end of surgery.
"It's about balance. To fix the gradient, change the pressure in front, or lower the pressure behind to match the pressure in front," Dr. Devgan said.
Editor's note: For more on Dr. Devgan's approach to managing iris prolapse, see "Management of iris prolapse in cataract surgery," published in the October 15 issue of Ocular Surgery News U.S. Edition.