March 28, 2023

Floppy iris is expected in such cases. Tips to manage such cases have been shared in this video.

The colleagues will come to my hospital at chronic heart west bengal india this patient is on temp solution for treatment of benign prostatic hyperplasia i am expecting floppy iris in this case let us see what happened and how i managed thickest the by this time the main incision has been placed it is selected site now 2% hydroxypropyl methylcellulose is being

Injected into the anterior chamber the patient is under topical anesthesia and am struggling to keep focus the centration is getting disturbed very frequently it happens in topical vehicle for the first two three minutes the patient moves his or her eyes a lot gradually take it adjusted to the light and they can cooperate better after 2-3 minutes so if you find that

The patient is moving he’s or higher eyes a lot don’t get scared the patient will be able to cooperate within a few minutes i never use intra chemical agents like preservative-free xylocaine i just do it with surface anesthesia with pro para cane eyedrops now hydro dissection i have done capsulorhexis with the 26 case with the needle in this case because i didn’t

Get enough series to go through the main side port the patient was moving a lot and it was easier for me to do texas through this side port with a needle so hydra dissection has been done and now is the main challenge and expecting floppy ideas in this case let us see what happens the vehicle handpiece is introduced into the antechamber some superficial cortical

Matter is removed now the vehicle handpiece is turned the bevel is turned towards the corneal endothelium now i introduce the chopper and as soon as i try to do direct job see what happens the iris tends to prolapse through the sideboard this is a very typical of floppy iris if the sideboard is little bigger it can come out through the sideboard in this case i

Opted to continue with chopping and emulsifying the cat rack does not charge it is quite soft and i could chop it and emulsify it very easily now i am trying to remove the abacus and this is very dangerous we must not use any power we must be very gentle very cautious the chamber should not be collapsing at any moment just have to hold the age of the ape anouk

Leus pull it at the center and then apply very minimal energy say only 10 purse and ultrasonic energy to emulsify the epi nucleus and remove it we may not use fake-o energy at all yes definitely has been removed now first remove the vehicle handpiece and then laid the chamber be shallow laid the iris retract and then remove the chopper otherwise you can injure

The itis yes whenever the iris is incarcerated in the wound always remove the fake o henry’s first let the chamber be shallow a bit and let the iris go into the anterior chamber and then remove the chopper and now the cortical matter is being removed but the tsimko if we use by manual it is okay but again if we use by manual the iris will tend to prolapse through

The cycles but with tsimko we can control that we can give the aspiration more than irrigation with tsimko we get more control and can prevent prolapse of iris through the side ports the patient could not cooperate well frequently keeping the other eye closed in spite of repeated instructions the eye ball is rolling upwards but the patient is not complaining of

Any pain although i am touching the iris at the end i asked whether the patient had experienced any pain or not and he said no so those of you who want to do phacoemulsification on the topical anesthesia just go ahead and practice with only surface anesthesia no intra chemical isn’t easy i’m doing topical fake-o for the last ten years or even more and i didn’t use

Intra camel isn’t i used in two three cases only in this last ten years it doesn’t help much and it is not necessary at all just surface anesthesia with prepare a cane eyedrops is enough in some cases you may need soft in an anesthesia as supplementary yes now i have i’m injecting the lens under risk of occurs visco has dilated the people of eid and it will help me

In visualizing the excess margin the lens that leading haptic has gone into the capsular bag and now the trailing haptic is going into the capsular bag the colleagues we never use viscoelastic surgeons for implantation of intraocular lens please remove the viscoelastic substance thoroughly if you don’t use tsimko use by manual irrigation aspiration for a longer

Time within fluffy iris this tsimko is wonderful because you can suck more than your irrigation and you can control the chamber much better yes with proper setting with by manual also with low bottle height you can prevent iris prolapse now after irrigating the anterior chamber for some time with the tsimko irrigation and aspiration for some more time removing

Lot of scholastic substance my aim is to have a quiet anterior chamber next day to see the normal happy face of the patient the patient should not complaining should not be complaining of any pain or any discomfort in the night and now i take the bai manual irrigation aspiration and use the by manual ia for some time here i have kept the bottle height little low

So that the irrigation is small still you can see that the iris is tending to prolapse tending to get incarcerated in these sy pots you can see the oblong iris because of its tendency to prolapse through these side boats yes the visco has been cleaned out very nicely now to buy some time because the antechamber is getting shallow inject air and then inject some

Antibiotic this is moxifloxacin then i hydrate the stroma on either side of the paracentesis openings and the paracentesis closes nicely if we hydrate this stroma these step bones become watertight and now is the time to do the final lavage of the anterior chamber yes this is my routine practice always do this final loveridge of the anterior chamber with balanced

Salt solution you can use pieces of any good company and do this lovage and you never he does next day if it is a good quality sterile basis and now the antechamber is formed nicely there should not be any leakage from any owned the determine is formed nicely and the case is concluded let these two air bubbles speed here in the anterior chamber thank you very much

For watching hope this video will help you in managing floppy aureus cases without using people expansion devices be better and do better

Transcribed from video
Phaco in a patient on Tamsulosin for benign prostatic hyperplasia : P Mohanta By Pradip Mohanta