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Gary Hirshfield MD
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After a misdirection of the hydrodissection fluid causes the iris to prolapse, Dr. Hirshfield reacts by expressing viscoelastic through the side port. He also discusses alternative approaches that would be effective in iris prolapse cases with different etiologies. After the iris is re-established, the case proceeds normally and concludes with ReSTOR +3 IOL implantation.
Posted: 8/11/2009
Gary Hirshfield MD
After a misdirection of the hydrodissection fluid causes the iris to prolapse, Dr. Hirshfield reacts by expressing viscoelastic through the side port. He also discusses alternative approaches that would be effective in iris prolapse cases with different etiologies. After the iris is re-established, the case proceeds normally and concludes with ReSTOR +3 IOL implantation.
Posted: 8/11/2009
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Comments
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Eugene Salvo
15 years ago
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.
pablo herrera
15 years ago
excelent video and thanks
ramiro marchesi
15 years ago
tahnks for the video..not only for show de the case ..its important that initial surgeins lerns to resolve the problem as you did.
Abdul Hamid Awan
15 years ago
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.
ari weitzner
15 years ago
i think youre absolutely right. makes perfect sense.
Abdul Hamid Awan
15 years ago
Thanks for the nice video with challenging introperative omplication.
Gary Hirshfield
15 years ago
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.
imran saleem
15 years ago
nice ,this has happened to me a couple of times but i could not find the cause,now i'll be cautious
Gary Hirshfield
15 years ago
To imransaleem
wamidh simawi
15 years ago
Nice Video demonstration of intra operative complication. Mannitol take probably more time ( than 20 min) to act. To prevent all these challenges
Gary Hirshfield
15 years ago
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.
Primoz Logar
15 years ago
Cleaning of viscoelastic from anterior chamber before hydrodissection can prevent trapping of BSS in vitreous
Hadisudjono Sastrosatomo
15 years ago
It is everybody's bad experience. Congratulation to this sharing through your excellent video.
yasar sakarya
15 years ago
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.
ari weitzner
15 years ago
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.
MARIA GESSA
16 years ago
Congratulations! This video is very helpful
George Tung
16 years ago
Well done video. I will keep this in mind when it happens to me. Thank you.
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