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Management of positive vitreous pressure and iris prolapse during cataract surgery

Poster Details

First Author: N.Surchev BULGARIA

Co Author(s):    Y. Kirilova   P. Vassileva                 

Abstract Details


To present two cases with intraoperative iris prolapse due to positive vitreous pressure and the steps undertaken to manage this intraoperative complication.


Both surgeries and follow up were performed at University Eye Hospital 'Prof. Pashev'.


Case review of the cataract phacoemulsification of a 62-year-old myopic woman with peripheral iridotomies for angle-closure glaucoma and 82-year-old hyperopic woman with pseudoexfoliation glaucoma. Intraocular pressure (IOP) was well controlled preoperatively with eye drops. Both patients were on systemic treatment for arterial hypertension. Cataract surgery was performed by standard horizontal chop technique.


Preop IOP was 18 and 20 mmHg, respectively. Upon creation of the side-ports a marked shallowing of the anterior chamber (AC) was observed combined with iris prolapse. Attempts to deepen the AC with viscoelastic agent and reposition the iris were only moderately effective, which necessitated the administration of mannitol intravenously. Following that the procedures were resumed and careful phacoemulsification with decreased infusion and dispersive-cohesive viscoelastic was carried out without further complications. Postoperatively the IOP remained under 18 mmHg in both cases, a mild transitory corneal edema was noted in the hyperopic patient with pseudoexfliation glaucoma.


Phacoemulsification offers a much more stable anterior chamber, compared to older cataract extraction techniques. Nevertheless, in some patients with predisposing factors (like instability of the iridolenticular diaphragm or crowded anterior chamber) there can be iris prolapse with all its negatve consequences for the surgical intervention. Our approach – combining hyperosmotic treatment and viscoelastic agent injection – offers an effective method for dealing with this type of complication without resorting to more invasive treatment options like vitreos tap.

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