2020–2021 BCSC Basic and Clinical Science Course™
11 Lens and Cataract
Chapter 10: Intraoperative Challenges in Cataract Surgery
Anterior Segment Complications
Iridodialysis and Iris Trauma
Iridodialysis, the tearing of the iris at its root or insertion, may occur at the time of insertion of the phaco tip or IOL. Traction on the iris root during phacoemulsification or irrigation/aspiration (I/A) can cause a tear and subsequent hyphema. If the iridodialysis is small or insignificant, it can be left alone. More extensive iridodialysis that could cause optical problems or be cosmetically significant may require surgical reattachment by suturing the iris to the sclera (Fig 10-3).
Chronic mydriasis or iris damage from surgery or trauma may cause the patient to experience excessive glare, particularly if the pupillary light response is inadequate or if the edge of the IOL is not covered. An iris defect may be repaired by a variety of techniques, including:
a McCannel suture technique with a Siepser sliding knot (see Chapter 11 for a discussion of dislocated IOLs)
a single-pass 4-throw pupilloplasty (Video 10-3)
pupillary cerclage (Video 10-4) or the implantation of artificial iris devices to alleviate symptoms or address a patient’s cosmetic concerns
postoperative use of an iris-colored contact lens as a nonsurgical alternative
Iris repair with single-pass 4-throw pupilloplasty. Courtesy of Jason Leng, MD.
Iris repair with pupillary cerclage. Courtesy of Jason Leng, MD.
Figure 10-3 Iridodialysis repair.
(Figure developed by Natalie Afshari, MD, and illustrated by Mark Miller.)
Excerpted from BCSC 2020-2021 series: Section 11 - Lens and Cataract. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.