Comparison of the effect of the intracameral lidocaine anesthesia and subconjunctival lidocaine anesthesia on the development of intraoperative floppy-iris syndrome in cataract surgery

BackgroundIntracameral Mydrane might facilitate a more streamlined cataract service and improve the patient experience. There is limited ‘real-world’ evidence of its use in a UK setting.MethodsAs part of a local evaluation of cataract surgery using intracameral Mydrane (group 2; n=60), data were collected on intraoperative pupil size and postoperative visual acuity (VA), as well as the rate of mechanical pupil dilation, intraoperative floppy iris syndrome (IFIS) and complications. Preoperative and theatre turnaround time was recorded and patients completed a validated measure of satisfaction postoperatively. Data were compared with a previous cohort subjected to the existing standard regime of preoperative topical mydriatics (group 1; n=60).ResultsPostoperative VA was comparable between groups (0.09±0.16 vs 0.08±0.15; p=0.59). Pupil size in group 2 was 7.0±1.0 mm prior to capsulorhexis and 6.5±0.29 mm after cortical aspiration, with a smaller pupil in patients on alpha-antagonists (4.7±1.1 mm; p=0.004) at this later time point. Comparing group 2 with group 1, preoperative waiting was less (87 vs 146 min; p<0.0001) and satisfaction was higher (76.0±11.2 vs 66.3±8.6; p<0.0001), although theatre turnaround time was longer (25 min vs 22 min).ConclusionIntracameral mydriasis was clinically effective in most patients undergoing cataract surgery and might be associated with an improved patient experience and a more streamlined preoperative flow. Mydrane represents a licensed alternative to the off-label use of other intracameral mydriatic agents, but was not judged to be a cost-effective intervention for routine use in this particular setting.

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Ophthalmology Residents' Experience with Complex Cataract Surgery at a VA Hospital over 10 Years

Journal of Academic Ophthalmology ◽

10.1055/s-0040-1709674 ◽

2020 ◽

Vol 12 (01) ◽

pp. e36-e40

Author(s):

Colleen Maturana ◽

Paul Lee ◽

Douglas Fredrick ◽

Nisha Chadha

Keyword(s):

Cataract Surgery ◽

Medical Center ◽

Cataract Extraction ◽

Veterans Administration ◽

Extracapsular Cataract Extraction ◽

Training Experience ◽

Administration Medical ◽

Capsular Tension Ring ◽

Intraoperative Floppy Iris Syndrome ◽

Competency Based

Abstract Objective The purpose of this study was to determine the proportion of complex cataract surgery performed by third-year ophthalmology residents at an academic Veterans Administration Medical Center. Methods A chart review was conducted of all resident cataract surgeries performed at the James J. Peters Veterans Administration Medical Center in The Bronx, NY between July 1, 2007, and June 30, 2017. Correct categorization was confirmed by review of operative report and reason for complex categorization was recorded, as well as the use and type of nonstandard device or technique. Results A total of 2,429 routine and 114 complex cataract surgeries were performed by 40 different residents over the 10-year period. In total, 4.5% of all cataract surgeries were categorized as complex. The most common reasons for complex categorization included intraoperative floppy iris syndrome (35.8%), miosis (38.4%), zonular instability (9.6%), mature cataract (7%), posterior synechiae (7.8%), and posterior capsular plaque (1.8%). Nonstandard techniques/devices included iris hooks (65.3%), pupil expansion device (8.5%), extracapsular cataract extraction (6.8%), synechiolysis (7.6%), mechanical iris dilation (0.8%), capsular tension ring (9.3%), and primary posterior continuous curvilinear capsulorhexis (1.7%). Conclusion A review of third-year resident cataract surgery experience at our institution's VA hospital where a significant amount of their surgical volume, approximately 50%, is obtained revealed that complex cataracts constituted a minimal portion of the cases. Education in cataract surgery should be competency based, extend beyond achieving minimums, and focus on variety and complexity of surgical experience. Formal tracking of routine versus complex cases should be considered to optimize training experience and assure patient safety.

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Medicinal mishaps: Tamsulosin-induced intraoperative floppy iris syndrome during cataract surgery

Australian Prescriber ◽

10.18773/austprescr.2010.042 ◽

2010 ◽

Vol 33 (3) ◽

pp. 88-89 ◽

Cited By ~ 1

Author(s):

Adrian Fung ◽

Peter McCluskey

Keyword(s):

Cataract Surgery ◽

Intraoperative Floppy Iris Syndrome

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Modified Surgical Techniques for Managing Intraoperative Floppy Iris Syndrome

Case Reports in Ophthalmological Medicine ◽

10.1155/2016/1289834 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4

Author(s):

Pornchai Simaroj ◽

Kaevalin Lekhanont ◽

Puwat Charukamnoetkanok

Keyword(s):

Surgical Technique ◽

Cataract Surgery ◽

Surgical Techniques ◽

Pupil Dilation ◽

Surgical Strategy ◽

Modified Technique ◽

Corneal Incision ◽

Intraoperative Floppy Iris Syndrome ◽

Iris Prolapse

Purpose.To report a modified surgical strategy in the management of intraoperative floppy iris syndrome-associated iris prolapse.Methods.Prolapsed iris is left as is and a new corneal incision near the original wound but at a different site is created. Depending on the location of the original incision and the surgeon’s preference, this additional incision can be used as a new port for phacoemulsification tip or can be the new site for the iris to securely prolapse, allowing for the surgery to proceed safely.Results.We present 2 cases of iris prolapse and inadequate pupil dilation in patients with IFIS. Along with our modified technique, additional iris retractors were placed to increase the workspace for the phacoemulsification tip. The cataract surgery was performed successfully without further complications in both cases.Conclusion.This surgical technique could be an adjunct to allow the surgeons to expand the armamentarium for the management of IFIS-associated iris prolapse.

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