Eyetube.net

I give all patients IV Mannitol(75 ml of 20% Mannitol) in the pre-op holding area prior to the case. This greatly decreases problems like this and lowers my blood pressure as well.

excelent video and thanks

tahnks for the video..not only for show de the case ..its important that initial surgeins lerns to resolve the problem as you did.

Well,it is my personal experience.BSS and viscoelastic like Healon may get trapped behind the cataract and temporarily push forward the lens thus causes iris to prolapse.One can try this technique to depress the lens back dentally after every injection of fluid during hydrodissection.Moreover topical anesthesia helps a lot to prevent intraocular pressure to rise during procedure.

i think youre absolutely right. makes perfect sense.

Awan- thanks for your comments- I agree except for one critical issue. I do not belief this problem is from BSS sequestered behind the nucleus at all. That would just force the nucleus to prolapse through the capsulorrhexis. The etiology is fluid being forced through the zonules and sequestered in the anterior vitreous. There is disagreement on this among experts.

Thanks for the nice video with challenging introperative omplication.

To imransaleem

nice ,this has happened to me a couple of times but i could not find the cause,now i'll be cautious

Nice Video demonstration of intra operative complication. Mannitol take probably more time ( than 20 min) to act. To prevent all these challenges

Agree 100 %, especially true with dispersive viscoelastics because a cohesive viscoelastic can be more easily pushed out of the eye in a single bolus by the fluid inflow. The dispersive viscoelastic blocks the fluid inflow of BSS from moving anteriorly increasing the likelihood that I will be forced through the zonules and into the vitreous.

Cleaning of viscoelastic from anterior chamber before hydrodissection can prevent trapping of BSS in vitreous

It is everybody's bad experience. Congratulation to this sharing through your excellent video.

i think he's right- if the bss were trapped in the capsular bag, the nucleus would be pushed out, and one could easily push it back, as we often do. here, the whole iris/capsule diaphragm is bulging forward- the bss is behind the posterior capsule as the good doctor suggests.

In this situation, the BSS is behind the nucleus between capsule and nucleus. I will prefer to push the nucleus towards the posterior capsule . this maneuver hepl the BSS come out through the capsulorhexis.

Well done video. I will keep this in mind when it happens to me. Thank you.

Congratulations! This video is very helpful