Iris Prolapse

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D Korzycka - One of the best experts on this subject based on the ideXlab platform.

  • Safety and efficacy of intra-operative sub-Tenon injection of 2% lidocaine in cases of unexpected intra-operative floppy Iris syndrome (IFIS)
    Acta Ophthalmologica, 2014
    Co-Authors: Anna Klysik, D Korzycka
    Abstract:

    Purpose To report safety and efficacy of intra-operative injection of 2% lidocaine during small incision cataract surgery in cases of unexpected intra-operative floppy Iris syndrome. Methods 4 patients, undergoing routine cataract surgery, who were exposed to alfa-adrenergic inhibitors, and it was not known pre-operatively, and in whom intra-operative floppy Iris syndrome occurred unexpectedly. 2.5 ml of 2% lidocaine was injected into the sub-Tenon space in response to intra-operative Iris Prolapse and pupillary constriction. Injection was performed following hydrodissection in 3 of 4 cases and hollowing capsulorrhexis in 1 of 4 cases. The surgery was video-taped from the beginning of the injection. Results No further Iris Prolapse was noted in any case, nor further pupillary constriction. Iris plane was stabilized. There were no further complications of cataract surgery. Patients were comfortable and pain free for the rest of the procedure. Conclusion Intra-operative injection of 2% lidocaine into the sub-Tenon space is a safe way of reversing Iris floppiness and the tendency to Iris Prolapsed in cases of unexpected intra-operative floppy Iris syndrome. It is an alternative to other intra-operative techniques to manage IFIS, which provides pain relief as well as Iris stabilization.

  • Sub‐Tenon injection of 2% lidocaine prevents intra‐operative floppy Iris syndrome (IFIS) in male patients taking oral α‐adrenergic antagonists
    Acta ophthalmologica, 2013
    Co-Authors: Anna Klysik, D Korzycka
    Abstract:

    . Purpose:  To compare 2% sub-Tenon and 1% intra-cameral lidocaine for cataract surgery in relation to the incidence and severity of IFIS. Prospective randomized clinical study. Methods:  From 81 eligible, we included 71 men aged from 59 to 90 years (mean 76.5 ± 6.8) undergoing routine cataract surgery and taking oral α-adrenergic antagonists, for urological reasons, for more than 1 year. Following randomization 34 men, aged from 62 to 90 years (mean 77.4 ± 8.1) received sub-Tenon injection of 2.5 ml of 2% lidocaine and the remaining 37 men aged from 59 to 89 years (mean 75.2 ± 7.2) received 1% preservative free intra-cameral lidocaine. Outcome measures were the incidence of IFIS, severity of intra-operative pupillary constriction and Iris Prolapse. Results:  Intra-operative floppy Iris syndrome (IFIS) was noted in 3 of 34 patients (8.8%) receiving sub-Tenon lidocaine and in 18 of 37 patients (48.6%) receiving intra-cameral lidocaine (p = 0.00). Severe IFIS was observed only in 3 of 37 patients (8.1%) receiving intra-cameral lidocaine. Pupil diameter at the end of surgery was 4.37 ± 1.07 mm in the sub-Tenon lidocaine group and 4.02 ± 1.06 mm in the intra-cameral lidocaine group (p = 0.00). Iris Prolapse was noted in two cases in the sub-Tenon lidocaine group and in 10 cases in the intra-cameral lidocaine group (p = 0.00). Twenty-five patients were receiving tamsulosin. The incidence of IFIS in tamsulosin subgroup was 76.9% (10 of 13 patients) in the intra-cameral lidocaine group and 16.6% (2 of 12 patients) in the sub-Tenon lidocaine group (p = 0.00). Conclusion:  Sub-Tenon lidocaine reduces significantly the incidence of IFIS in patients taking oral α-adrenergic inhibitors as compared with intra-cameral lidocaine.

Dennis Brooks - One of the best experts on this subject based on the ideXlab platform.

  • visual outcome after corneal transplantation for corneal perforation and Iris Prolapse in 37 horses 1998 2010
    Equine Veterinary Journal, 2012
    Co-Authors: M. De Linde Henriksen, Caryn E. Plummer, Brendan G. Mangan, Hiroki Tsujita, Shari M. Greenberg, Nils Toft, Gil Benshlomo, Dennis Brooks
    Abstract:

    Summary Reasons for performing study We wanted to investigate the visual outcome of horses presented with Iris Prolapse and treated with corneal transplantation. Objective To evaluate the visual outcome of horses with Iris Prolapse treated with penetrating keratoplasty alone and penetrating keratoplasty in combination with overlying conjunctival or amniotic membrane grafting. Methods A retrospective medical records study of horses presented to the University of Florida Veterinary Medical Center for Iris Prolapse and treated with penetrating keratoplasty in the period of 1998-2010. Data collected from the medical records included signalment, clinical descriptions of ocular lesions, treatments, and therapeutic outcome. Results Iris Prolapses in this study were caused by corneal ulcers with keratomalacia (n = 37). All horses were treated medically for infection, hyperproteinase activity and iridocyclitis, and then surgically treated with either penetrating keratoplasty alone (n = 9) or penetrating keratoplasty with either a conjunctival pedicle flap (n = 22), amniotic membrane transplant (n = 5) or amnion membrane and conjunctival pedicle flap (n = 1). The eyes were visual postoperatively in a majority of the cases (n = 24; 64.9%). Limited vision was noted in 6 eyes (16.2%), 3 eyes became phthisical (8.1%) and 4 globes were enucleated (10.8%). Graft rejection manifested as some degree of donor corneal graft opacification in all cases. Anterior synechiae were present in 48.6% of the eyes. Wound dehiscence and aqueous humour leakage were also common as post operative problems. Conclusion Penetrating keratoplasty alone or in combination with an overlying graft of conjunctiva or amniotic membrane can achieve a successful visual outcome in a high percentage of horses with Iris Prolapse.

  • Visual outcome after corneal transplantation for corneal perforation and Iris Prolapse in 37 horses: 1998–2010
    Equine veterinary journal. Supplement, 2012
    Co-Authors: M. De Linde Henriksen, Caryn E. Plummer, Brendan G. Mangan, Gil Ben-shlomo, Hiroki Tsujita, Shari M. Greenberg, Nils Toft, Dennis Brooks
    Abstract:

    Summary Reasons for performing study We wanted to investigate the visual outcome of horses presented with Iris Prolapse and treated with corneal transplantation. Objective To evaluate the visual outcome of horses with Iris Prolapse treated with penetrating keratoplasty alone and penetrating keratoplasty in combination with overlying conjunctival or amniotic membrane grafting. Methods A retrospective medical records study of horses presented to the University of Florida Veterinary Medical Center for Iris Prolapse and treated with penetrating keratoplasty in the period of 1998-2010. Data collected from the medical records included signalment, clinical descriptions of ocular lesions, treatments, and therapeutic outcome. Results Iris Prolapses in this study were caused by corneal ulcers with keratomalacia (n = 37). All horses were treated medically for infection, hyperproteinase activity and iridocyclitis, and then surgically treated with either penetrating keratoplasty alone (n = 9) or penetrating keratoplasty with either a conjunctival pedicle flap (n = 22), amniotic membrane transplant (n = 5) or amnion membrane and conjunctival pedicle flap (n = 1). The eyes were visual postoperatively in a majority of the cases (n = 24; 64.9%). Limited vision was noted in 6 eyes (16.2%), 3 eyes became phthisical (8.1%) and 4 globes were enucleated (10.8%). Graft rejection manifested as some degree of donor corneal graft opacification in all cases. Anterior synechiae were present in 48.6% of the eyes. Wound dehiscence and aqueous humour leakage were also common as post operative problems. Conclusion Penetrating keratoplasty alone or in combination with an overlying graft of conjunctiva or amniotic membrane can achieve a successful visual outcome in a high percentage of horses with Iris Prolapse.

  • Optimal management of equine keratomycosis
    Veterinary medicine (Auckland N.Z.), 2012
    Co-Authors: Paula Diniz Galera, Dennis Brooks
    Abstract:

    Keratomycosis in the horse exists in several unique clinical forms. This paper discusses the diagnosis and clinical management of keratomycosis in the horse associated with tear film instability, epithelial keratopathy, subepithelial infiltrates, superficial and deep ulcers, plaques, melting ulcers, descemetoceles, Iris Prolapse, and stromal abscesses. Prompt diagnosis and aggressive treatment of equine keratomycosis can make a major difference in the maintenance of a cosmetic and visual eye.

  • Visual outcome and ocular survival following Iris Prolapse in the horse: a review of 32 cases
    Equine Veterinary Journal, 2010
    Co-Authors: N. T. Chmielewski, Smith Pj, C. J. G. Whittaker, Diane V. H. Hendrix, Dennis Brooks, Kirk N. Gelatt
    Abstract:

    Summary The medical records of 32 horses treated for Iris Prolapse (IP) during an 8 year period, at the University of Florida Veterinary Medical Teaching Hospital, were reviewed. Iris Prolapse was associated with perforated corneal ulcers in 15 horses (47%), ruptured stromal abscesses in 2 horses (6%), and full thickness corneal lacerations in 15 horses (47%). Initial ophthalmic examinations revealed IP with severe iridocyclitis in all eyes and keratomalacia in 8 eyes with corneal ulcers, one with a stromal abscess and 1 with a corneal laceration. Hyphema was present in 7 eyes with corneal lacerations. Thirty horses were managed with combined medical and surgical therapy. Two horses were only treated medically with topically administered antibiotics. Of the 24 perforations surgically repaired, 21 were closed primarily and 13 were then covered with a conjunctival graft. After combined therapy and a minimum of 4 months of follow-up, vision was retained in 6 of the horses (40%) with perforating corneal disease and 5 of the horses (33%) with perforating corneal lacerations. Post operatively, of the 11 (37%) horses blind at discharge, 6 (55%) subsequently developed phthisis bulbi. Enucleations were performed in 4 cases with extensive keratomalacia and/or endophthalmitis, 2 cases with limbal rupture and total hyphema, and one case with a chronic IP. One horse was subjected to euthanasia after 3 surgical treatments failed to stabilise stromal melting. Horses presented with ulcerative keratitis of fewer than 15 days duration, or horses with corneal lacerations less than 15 mm in length, tended to have a favourable visual outcome. Keratomalacia, hyphema, corneal lacerations longer than 15 mm and lacerations extending to, along, or beyond the limbus, adversely influenced visual outcome. Iridectomy did not appear clinically to exacerbate anterior uveitis or adversely affect visual outcome. Ocular survival following combined therapy was 80% (12/15) in horses with corneal lacerations and 67% (10/15) in horses with ulcerative keratitis.

  • Penetrating keratoplasty for treatment of corneal protrusion in a great horned owl (Bubo virginianus).
    Veterinary ophthalmology, 2002
    Co-Authors: Stacy E. Andrew, Dennis Brooks, Tracy L. Clippinger, Kelly E. Helmick
    Abstract:

    A young adult great horned owl (Bubo virginianus) was examined following presumed trauma. The owl had soft tissue injury to its left wing as well as corneal protrusion, lens subluxation, and iridodialysis of the right eye. The bird's eye was treated surgically with a large, rectangular penetrating keratoplasty. Following escape from housing, the bird was found with partial wound dehiscence and Iris Prolapse 12 days post operation. Surgical repair was performed and healing progressed for 14 days, at which time the transplant dehisced and the globe was exenterated. The patient rehabilitated well until escaping from its cage again 4 weeks later, at which time it sustained an open comminuted humeral fracture and was euthanized.

Philip Alexander - One of the best experts on this subject based on the ideXlab platform.

  • Management of intraoperative Iris Prolapse: Stepwise practical approach
    Journal of cataract and refractive surgery, 2012
    Co-Authors: Naing L Tint, Amritpaul S. Dhillon, Philip Alexander
    Abstract:

    Iris Prolapse is not an uncommon occurrence during cataract surgery. It usually occurs through the main incision during hydrodissection and is commonly associated with floppy-Iris syndrome; however, it can manifest in cases with no known predisposition and can occur at any stage during surgery. The mechanism is explained by the Bernoulli principle and its effect on Iris position during the movement of fluid within the eye. Predisposing factors are Iris configuration, anterior chamber depth, and position and architecture of the corneal tunnel. Strategies for prevention and management include the use of pharmacological agents, ophthalmic viscosurgical devices, and Iris retractors. These strategies can be augmented by alteration and adaptation of the surgeon's technique.

  • management of intraoperative floppy Iris syndrome associated Iris Prolapse using a single Iris retractor
    Journal of Cataract and Refractive Surgery, 2009
    Co-Authors: Naing L Tint, Aaron M Yeung, Philip Alexander
    Abstract:

    Tamsulosin is an α 1 -adrenergic antagonist known to be linked with intraoperative floppy-Iris syndrome (IFIS), which is characterized by Iris atonicity and a propensity toward progressive intraoperative pupil constriction and Iris Prolapse. We present 2 strategies for managing IFIS-associated Iris Prolapse. Placement of a single subincisional Iris retractor following reposition of the Prolapsed Iris was the more successful approach. We recommend consideration of this approach in all cases of Iris Prolapse.

Anna Klysik - One of the best experts on this subject based on the ideXlab platform.

  • Safety and efficacy of intra-operative sub-Tenon injection of 2% lidocaine in cases of unexpected intra-operative floppy Iris syndrome (IFIS)
    Acta Ophthalmologica, 2014
    Co-Authors: Anna Klysik, D Korzycka
    Abstract:

    Purpose To report safety and efficacy of intra-operative injection of 2% lidocaine during small incision cataract surgery in cases of unexpected intra-operative floppy Iris syndrome. Methods 4 patients, undergoing routine cataract surgery, who were exposed to alfa-adrenergic inhibitors, and it was not known pre-operatively, and in whom intra-operative floppy Iris syndrome occurred unexpectedly. 2.5 ml of 2% lidocaine was injected into the sub-Tenon space in response to intra-operative Iris Prolapse and pupillary constriction. Injection was performed following hydrodissection in 3 of 4 cases and hollowing capsulorrhexis in 1 of 4 cases. The surgery was video-taped from the beginning of the injection. Results No further Iris Prolapse was noted in any case, nor further pupillary constriction. Iris plane was stabilized. There were no further complications of cataract surgery. Patients were comfortable and pain free for the rest of the procedure. Conclusion Intra-operative injection of 2% lidocaine into the sub-Tenon space is a safe way of reversing Iris floppiness and the tendency to Iris Prolapsed in cases of unexpected intra-operative floppy Iris syndrome. It is an alternative to other intra-operative techniques to manage IFIS, which provides pain relief as well as Iris stabilization.

  • Sub‐Tenon injection of 2% lidocaine prevents intra‐operative floppy Iris syndrome (IFIS) in male patients taking oral α‐adrenergic antagonists
    Acta ophthalmologica, 2013
    Co-Authors: Anna Klysik, D Korzycka
    Abstract:

    . Purpose:  To compare 2% sub-Tenon and 1% intra-cameral lidocaine for cataract surgery in relation to the incidence and severity of IFIS. Prospective randomized clinical study. Methods:  From 81 eligible, we included 71 men aged from 59 to 90 years (mean 76.5 ± 6.8) undergoing routine cataract surgery and taking oral α-adrenergic antagonists, for urological reasons, for more than 1 year. Following randomization 34 men, aged from 62 to 90 years (mean 77.4 ± 8.1) received sub-Tenon injection of 2.5 ml of 2% lidocaine and the remaining 37 men aged from 59 to 89 years (mean 75.2 ± 7.2) received 1% preservative free intra-cameral lidocaine. Outcome measures were the incidence of IFIS, severity of intra-operative pupillary constriction and Iris Prolapse. Results:  Intra-operative floppy Iris syndrome (IFIS) was noted in 3 of 34 patients (8.8%) receiving sub-Tenon lidocaine and in 18 of 37 patients (48.6%) receiving intra-cameral lidocaine (p = 0.00). Severe IFIS was observed only in 3 of 37 patients (8.1%) receiving intra-cameral lidocaine. Pupil diameter at the end of surgery was 4.37 ± 1.07 mm in the sub-Tenon lidocaine group and 4.02 ± 1.06 mm in the intra-cameral lidocaine group (p = 0.00). Iris Prolapse was noted in two cases in the sub-Tenon lidocaine group and in 10 cases in the intra-cameral lidocaine group (p = 0.00). Twenty-five patients were receiving tamsulosin. The incidence of IFIS in tamsulosin subgroup was 76.9% (10 of 13 patients) in the intra-cameral lidocaine group and 16.6% (2 of 12 patients) in the sub-Tenon lidocaine group (p = 0.00). Conclusion:  Sub-Tenon lidocaine reduces significantly the incidence of IFIS in patients taking oral α-adrenergic inhibitors as compared with intra-cameral lidocaine.

Michael B. Phillips - One of the best experts on this subject based on the ideXlab platform.

  • Preoperative use of atropine to prevent intraoperative floppy-Iris syndrome in patients taking tamsulosin
    Journal of cataract and refractive surgery, 2006
    Co-Authors: Rick E. Bendel, Michael B. Phillips
    Abstract:

    Intraoperative floppy-Iris syndrome (IFIS) is a recently identified condition associated with phacoemulsification in patients using the α 1 -antagonist tamsulosin (Flomax). Patients with IFIS manifest a triad of symptoms during cataract surgery: fluttering and billowing of Iris stroma due to normal fluid movement, propensity of Iris Prolapse to phaco and side-port incisions, and progressive constriction of the pupil. Prevention of IFIS by withdrawing tamsulosin preoperatively has not shown consistent benefit. We describe the preoperative administration of atropine, which effectively prevented the occurrence of IFIS in patients receiving tamsulosin.