Cases reported "Iris Diseases"

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1/17. Severe iridodialysis from phacoemulsification tip suction.

    During cataract surgery, the iris of an 83-year-old woman was strongly sucked into the phacoemulsification tip twice, resulting in severe iridodialysis. The dehisced iris was sutured to the sclera using double-armed 10-0 polypropylene on a long curved needle. Intensive suction of the iris by the phacoemulsification tip can lead to severe iridodialysis. Machine setting parameters, particularly flow rate, should be lowered after the first iris suction to avoid further iris damage.
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2/17. Flexible iris hooks for phacoemulsification in patients with iridoschisis.

    Flexible iris hooks, or retractors, can be used to facilitate cataract removal by phacoemulsification in patients with primary iridoschisis. This rare condition is associated with fibrillary degeneration of the iris, narrow drainage angles, and cataract. In addition to their conventional use as iris retractors, iris hooks can control the degenerate fibrillary iris stroma to improve the view and access to the lens, preventing further damage during phacoemulsification and cortical cleanup. iris hooks are widely available, easily handled, and can transform a difficult case into one that is almost routine.
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keywords = phacoemulsification
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3/17. Management of atypical epicapsular star.

    An 18-year-old woman had brown pigment deposits on the central anterior capsule of the lens associated with poor visual acuity and significant anisometropia. Surgical removal of the deposits, phacoemulsification, and intraocular lens implantation resulted in visual improvement. Epicapsular stars are formed by the confluence of multiple fine pigmentary deposits. Although they cause amblyopia, this does not appear to be dense. Surgical removal of these central deposits may improve vision, even if the patient presents as an adult.
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keywords = phacoemulsification
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4/17. iris alteration using mechanical iris retractors.

    A 74-year-old woman had a 3-port pars plana vitrectomy for a dropped nucleus after complicated phacoemulsification. Flexible nylon iris retractors were positioned to dilate the small pupil. The patient died of a pulmonary embolus 1 day after surgery. The eyeball was removed at autopsy, and pathology of the iris was investigated. Localized damage to the iris where the retractor hooks were positioned was noted, but no other alterations to the iris were observed. These findings may explain the recovery of pupil function that is common after surgery with mechanical iris retractors.
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keywords = phacoemulsification
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5/17. Pseudophakic pupillary block caused by pupillary capture after phacoemulsification and in-the-bag AcrySof lens implantation.

    We describe a 50-year-old patient who developed pupillary block caused by pupillary capture 1 week after uneventful phacoemulsification and implantation of an AcrySof foldable intraocular lens (IOL). The patient had a large but intact capsulorhexis with the haptics lying in the bag; the optic lay in the pupillary area anterior to the capsulorhexis. This case was successfully managed by a neodymium: YAG laser iridotomy, IOL explantation, and subsequent implantation of a poly(methyl methacrylate) posterior chamber IOL. To prevent this complication, we suggest the optic be larger than the capsulorhexis and advocate correct, gentle insertion of the foldable IOL.
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keywords = phacoemulsification
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6/17. Expulsion of an intraocular lens through a clear corneal wound.

    A 91-year-old man sustained blunt trauma to an eye that had uneventful phacoemulsification through a superior clear corneal incision 5 years earlier. The silicone foldable intraocular lens (IOL) and a portion of the iris and capsular bag were expulsed through the cataract excision, which then self-sealed. This case illustrates the potential for expulsion of foldable IOLs through small clear corneal incisions even several years after surgery.
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ranking = 0.16666666666667
keywords = phacoemulsification
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7/17. Ultrasound biomicroscopy in the diagnosis of a primary peripheral iris cyst.

    A primary peripheral cyst behind the iris is difficult to detect during a routine slit lamp examination. It is usually asymptomatic unless the cyst is sufficiently large. We report on a 73-year-old woman who underwent phacoemulsification of a cataract and incidentally presented a small dark mass behind the peripheral iris. The lesion was initially suspected of being a melanoma, but it could not be localized by conventional techniques postoperatively. A diagnosis of primary iris cyst was not made until 1 year later when high-frequency ultrasound biomicroscopy (UBM) was employed. UBM displayed a distinct thin-wall cystic lesion (0.5 x 0.8 x 0.6 mm) with low internal reflectivity at the iridociliary sulcus of the inferotemporal quadrant. UBM allows good imaging access to a lesion behind the iris that is otherwise difficult to detect with traditional techniques.
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ranking = 0.16666666666667
keywords = phacoemulsification
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8/17. iridectomy of the anterior iris stroma using the vitreocutter during phacoemulsification in patients with iridoschisis.

    We present a technique to manage iridoschisis. This technique for anterior iridectomy of the affected iris fibers avoids intraoperative obstruction of the phaco tip and prevents postoperative complications such as corneal decompensation and glaucoma. Before the capsulorhexis is created, a vitreocutter is inserted in the anterior chamber and used to cut the iris strands at the site of the iridoschisis, making an anterior sectorial stromal iridectomy and preserving the iris pigment epithelium. phacoemulsification is then performed. After the pupil is constricted with carbacol, remnants of the loose anterior iris fibers are excised with the vitreocutter and the scleral incision is sutured.
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keywords = phacoemulsification
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9/17. Avoiding iris trauma from phacoemulsification in eyes with iridoschisis.

    Iridoschisis is a rare condition frequently associated with age-related cataract. phacoemulsification can be difficult to perform in these eyes, as the detached iris fibrils that are typically present free float in the anterior chamber and are attracted to the phaco tip and the irrigation/aspiration handpiece port. We describe a technique for performing phacoemulsification in eyes with iridoschisis. In this technique, iris fibrils are held in place by 2 ophthalmic viscosurgical devices (OVDs) that are injected into the inferior portion of the anterior chamber. An elliptical capsulorhexis is made and limited to the superior half of the pupil for additional stability of the anterior chamber during surgery. The nucleus is chopped with a phaco chopper and a bent-tip, 22-gauge needle. Most of the phacoemulsification is performed under the anterior capsule. The iris comes into contact with the OVDs only and has no mechanical trauma.
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keywords = phacoemulsification
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10/17. Management of lens-iris diaphragm retropulsion syndrome during phacoemulsification.

    Lens-iris diaphragm retropulsion syndrome (LIDRS) occurs more often than recognized during small-incision phacoemulsification. This syndrome requires an infusion of fluid into the anterior chamber and is characterized by posterior displacement of the lens-iris diaphragm, marked deepening of the anterior chamber, posterior iris bowing, pupil dilation, and often significant patient discomfort. Using microendoscopy, we have observed that LIDRS is essentially a reverse pupillary block. We describe a surgical technique to mechanically break the iridocapsular block to restore normal chamber depth, relieve patient discomfort, and allow the surgeon to proceed safely with phacoemulsification.
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keywords = phacoemulsification
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