The Incidence and Risk Factors of Lens-iris Diaphragm Retropulsion Syndrome during Phacoemulsification

Lens-Iris diaphragm retropulsion syndrome: Risk factors and management. A prospective study

Purpose

The lens-iris diaphragm retropulsion syndrome (LIDRS) corresponds to an acute deepening of the anterior chamber during phacoemulsification. LIDRS is painful for the patient and sometimes causes intraoperative complications. This study was designed to assess the preoperative risk factors of LIDRS and its outcome.

Setting

Monocentric study in the university department of ophthalmology, Intercommunal Hospital Center, Creteil, France.

Design

Prospective observational study.

Methods

Preoperative parameters of consecutive patients who underwent cataract surgery were recorded. LIDRS occurrence was evaluated during surgery and classified into 3 stages. Except for the first patient, a simple and rapid maneuver to separate the iris from the capsule was performed in all patients with LIDRS.

Results

LIDRS occurred in 101 out of 205 included eyes: mild in 73.2%, marked in 16.8%, and severe in 9.9%. LIDRS patients were younger, and had a longer axial length and a thinner lens than the control group (p < 0.01 for all). Univariate logistic regression showed that the main predictive factors of LIDRS were long axial length and decreased lens thickness. LIDRS occurred in 83% (5/6) of eyes with prior vitrectomy. Complications occurred (zonular dehiscence, lens or IOL dislocation), especially in vitrectomized eyes. The maneuver separating the iris from the capsule allowed almost all eyes to restore normal chamber depth and prevent complications.

Conclusions

Myopia and prior vitrectomy were the main risk factors of LIDRS. The maneuver separating the iris from the capsule allowed almost all eyes to resolve LIDRS. Analysis of preoperative factors can help the surgeon identify patients at risk and prevent patient pain and intraoperative complications associated with LIDRS.

Safety and effectiveness of an iris hook assisted phacoemulsification in vitrectomized eyes

AIM

To introduce a simple iris hook assisted phacoemulsification (PE) procedure and evaluate the safety and efficacy of it in completely vitrectomized eyes.

METHODS

A single centre study which included 65 previously completely vitrectomized eyes of 62 patients who underwent cataract surgery. Patients were randomly divided into 3 groups. Patients received PE, and intraocular lens (IOL) implantation with the assistance of iris hook (Synergeties™) as group A (25 eyes); patients who received PE assisted with a 25G pars plana irrigation as group B (20 eyes), and patients who received PE performed without the help of any instrument as group C (20 eyes). Main outcome measures were surgery duration, Ultrasound (U/S) total time, endothelial cell density (ECD), cumulative dissipated energy (CDE) and complications of the procedures.

RESULTS

With the help of iris hook, the patients in group A had the lowest ECD loss rate (0.07±0.03, 0.09±0.03, and 0.10±0.03, P<0.05), shortest CDE (12.2±4.1, 15.8±6.0, and 16.0±6.0, P<0.05) and U/S total time (36.6±13.0s, 46.3±16.4s, and 47.6±16.1s, P<0.05), and minimal incidence of complications. The longest surgery duration was in group B (19.4±1.6min) and maximum complications rate in group C (20% miosis, 10% posterior capsular tears, 5% zonular dialysis, 5% cystoid macular edema). While best-corrected visual acuity (BCVA), intraocular pressure (IOP) and ECD did not show a significant difference among the three groups.

CONCLUSION

Without prolonged surgery duration, the iris hook assistant method can minimize heat generation during surgery and incidence of complications, which transfer the challenged PE in vitrectomized eyes into a regular surgery. It does not need any change in the hydrodynamic parameters and in the bag PE technique, easy to operate even for junior surgeons.