Update on management of intraoperative iris prolapse

This is a great review article that discusses the predisposing factors, preventive measures and intraoperative strategies for intraoperative iris prolapse. It is well-presented and focuses on the general management of intraoperative iris prolapse during phacoemulsification cataract surgery in cases with and without intraoperative floppy iris syndrome.

Predisposing factors for intraoperative iris prolapse are iris configuration, anterior chamber depth, and position and architecture of the corneal tunnel. Strategies for prevention and management include the use of pharmacological agents, ophthalmic viscosurgical devices and iris retractors. These strategies can be augmented by alteration and adaptation of the surgeon's technique.

Anyone who still sees temporal transillumination defects postoperatively owes it to their patients to take the advice given in this article, which advocates the early use of iris retractors, either prophylactically when the risk for prolapse may be high or after a single episode of prolapse, rather than placing them after multiple episodes of prolapse. This will reduce iris trauma and loss of pigmented epithelium, which can lead to transillumination defects or monocular diplopia.