Posters

Minimal modification of iris anatomy and no blood loss following iris capture during nanolaser photofragmentation cataract surgery in a patient with intraoperative floppy iris syndrome

Poster Details

First Author: G.Sauder GERMANY

Co Author(s):                        

Abstract Details

Purpose:

Intraoperative floppy iris syndrome is characterized by a flaccid iris that billows with intraocular fluid currents, a propensity to prolapse towards the area of cataract extraction, and progressive intraoperative pupil constriction. It occurs in 4% of the general population and up to 86% in patients in therapy with tamsulosin. Capture of the iris during phacoemulsification can cause bleeding and significant modification of the iris anatomy, further complicating the procedure. Capturing the iris during photofragmentation with a nanosecond laser seldom produces bleeding and causes a negligible modification of the iris anatomy.

Setting:

Charlottenklinik für Augenheilkunde, Stuttgart, Germany

Methods:

A 67-year-old man in therapy for benign prostatic hyperplasia presented intraoperative floppy iris syndrome during a routine procedure of nanosecond laser photofragmentation cataract surgery. During the removal of the cataract, the iris was accidentally captured. This intraoperative complication did not produce bleeding and the procedure was successfully completed without further incidents. A comparison of the pupil border in pre- and post-capture surgical microscope images indicated that a less than 1% modification of the iris anatomy was induced by this event.

Results:

Nanosecond photofragmentation was reported to be gentler on the endothelial cells mainly due to the reduced quantity of energy introduced into the eye, but also due to the lack of movement of the tip during energy release. The margin of the opening is also blunt. Photofragmentation currently still requires a greater amount of fluidics that increases the risk of iris capture in patients who present intraoperative floppy iris syndrome. This latter disadvantage is amply compensated by the negligible damage induced by iris capture during photofragmentation. This case report is typical representative of the cases of iris capture I have observed during the over 6000 nanolaser photofragmentation procedures performed to date.

Conclusions:

Nanosecond laser photofragmentation could represent a valid alternative in patients with an increased risk of intraoperative floppy iris syndrome, especially when adequate pupil dilation cannot be achieved. The modification of iris anatomy in the event of iris capture is minimal and amply compensates for the marginal increased risk caused by the slight increase in fluidics required with this technique. This is another aspect of how nanosecond laser photofragmentation is gentler then photofragmentation and could represent a valid alternative in the hands of less experienced cataract surgeons.

Financial Disclosure:

None