9 6
O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E | O C T O B E R 2 0 1 4
— to 5 or 6 mm — and looks like it's going to
provide trouble during the procedure, he
inserts an expansion ring or uses iris hooks to
make the case routine. He also employs a
bimanual microincisional technique, which
keeps the irrigation flow above the iris plane
for the majority of the case, meaning it's less
likely to cause billowing of the iris and aggra-
vate a floppy iris.
Dr. Melendez says 2% to 3% of his patients —
typically those on Flomax — present with
IFIS. When operating on these patients, he
lowers the phacoemulsification's vacuum set-
tings, lowers the bottle height and tries to stay
anterior to the iris plane, because, he says, as
soon as fluid gets under the posterior iris, IFIS
gets significantly worse.
Should surgeons use iris hooks or expan-
sion rings to expand floppy irises? That
depends on the surgeon, says Dr. Hoffman,
who says hooks are the better option in
patients with very shallow anterior chambers,
when there are adhesions between the iris
and the cornea or a defect on the iris.
"My preference is to use a ring," he says.
"But when it won't fit onto the pupil because
of adherent leukoma of the iris or large
defects, then the hooks are a better choice."
Dr. Melendez says his rate of using hooks
has dropped significantly since using preser-
O P H T H A L M O L O G Y
Call AOI for Information
800.576.1266 or
949.580.1266
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