Cataract surgery management in eyes with extensive iridoschisis

Purpose: To demonstrate an approach to the problems of cataract surgery in extensive iridoschisis Methods: Four eyes of 2 patients with extensive iridoschisis had cataract surgery by the same surgeon using the techniques that resembled techniques for phacoemulsification in intraoperative floppy iris syndrome (IFIS). We used low flow parameters on phacoemulsification, used super-cohesive ophthalmic viscosurgical devices (OVDs), avoided iris stretching, inserted iris hooks, administrated topical atropine preoperatively, and injected intracameral epinephrine. Results: Iris fibrils remained immobile during the procedure, and despite the severity of iridoschisis, there was no iris attachment to phaco tip, iris billowing, or iris prolapse during phacoemulsification. None of the eyes developed posterior capsule rupture. Conclusion: In severe iridoschisis patients, there are risks of aspiration of iris fibers and iris prolapse during cataract surgery. These might be prevented by combination of using super-cohesive OVDs, avoidance of iris stretching, insertion of iris hooks, preoperative administration of topical atropine, and intracameral epinephrine.