Forcefully Dislodged Viscoelastic Cannula Intraoperatively Resulting In Severe Iridodialysis, Lens Subluxation, And Hyphema

To report an uncommon complication during phacoemulsification related to dislodged cannula.

Single medical center of Taiwan.

Case report.

We report a 59 year old female patient who was referred to our hospital due to intraoperative viscoelastic cannula shot off during cataract surgery resulting in left eye severe iridodialysis approximately 240 degrees, accompanied with lens subluxation and hyphema. Further surgical intervention was carried out to complete cataract extraction and intraocular lens implantation. Iris was retracted by iris hooks while cataract was extracted by careful phacoemulsification and intraocular lens implantation. Due to massive iridodialysis, we modified the technique and made a 6-0 polypropelene flange for anchoring of the iris ribbon, followed by two individual modified sewing machine technique on each sides with 10-0 polypropelene sutures.

Various syringes and cannulas were commonly used in opthalmology practice. Possible hazzards may occur when the  cannula is loosely-attached during procedures that require force, such as viscoelastic injection, hydrodissection, or  stromal hydration. The dislodged cannula may cause damage to the cornea, iris, crystaline lens, or even the retina,  resulting in a complicated cataract surgery. Although rare, cautions should taken when administrating viscoelastics or  other fluids with a cannula. Furthermore, in this case, we demonstrated a modified version of the modified sewing machine method as described by Dr. Marina Shanturova for repair of large angle iridodialysis.