Modified Surgical Techniques for Managing Intraoperative Floppy Iris Syndrome

Figure 1

Photographs demonstrating our surgical technique to manage IFIS. In Patient 1, the iris prolapsed during hydrodissection and hydrodelineation (a). Prolapsed iris was left incarcerated in the first incision. Two iris retractors were placed to ensure adequate pupil size and the second main incision was made at 12 o’clock (b). Phacoemulsification was continued via the new superior incision (c). Prolapsed iris tissue was repositioned with OVDS after IOL implantation and OVDS removal (d). In Patient 2, during hydrodissection, the iris prolapsed through the main incision, similar to Patient 1 (e). The second main incision was created lateral to the original incision (f). Phacoemulsification was attempted via the new incision but the pupil started to constrict (g). Phacoemulsification was then performed via the original main wound instead, leaving the iris prolapsed through the second main wound. Nonetheless, the pupil was getting more constricted (h). Three iris retractors were placed and the surgery was continued without further complications (i). Each main wound was sutured at the completion of surgery (j).

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