Floppy iris Syndrome

Presentation about Floppy Iris Syndrome by David Chang. Excellent talk and worth a read. Posting it for those who may not be members of American Academy of Ophthalmology or just missed it

1. AMERICAN ACADEMY"
OF OPHTHALMOLOGY

Intraoperative Floppy Iris Syndrome:
Pearls for Management and Prevention

Senior Instructor: David F Chang MD
Course: 214

Sunday, October 16, 2016
10:15 AM - 11:15 AM

Room: E451A

Published: 8-12-16 12:55 AM

Join the conversation: #aa02016

13. UCSF Collaborative Research Net

14. Steve A Arshinoff MD FRCSC OVD Stepladder Approach to IFIS AAO 2014

Managing Flomax IFIS in ovos‘)
A Step Ladder Approach

2014

yA

iva aye

“Phaco is Rheology”

wo physical components of Phacı
m

OVDs are pseudoplastic luis used to reale an AC surgical |
‘environment optimized or surgery.

Creative use of OVDs reduces complication rates,

TSST

Tri-Soft Shell Technique (TSST)

Successfully Managing IFIS with OVDs

© Step 1: Studythe eye & warn patient,
Perform preop dilation test.

© Step 2: Prepare the AC.
© Step 3: Create IFIS Soft Shell Bridge (SSB)

2 Step 4: Performlow flow, low turbulence surgery.

ios Malyugin Ring (or ris ENT |

15. OVD Stepladder Approach to IFIS

AAO 2014

Successfully Managing IFIS with OVDs

Step 1: Study the eye & warn patient.
Perform preop dilation test
ce

© Step3: Create IFIS Soft Shell Bridge (SSB)

© step 4

(M: Malyugin Ring, (or iris retractors) ee |

Perform low flow, low turbulence surgery.

Warn Flomax pts:

Flomax patients are asked to
have their doctor change them
to a different BPH a blocker
before surgery.

{This may not make much difference.)

-— | Jj

Step 1: Carefully examine iris 8 pupil

0e al small pupil cases $2 weeks preop!

POP eg? intracam.Xylo-phe.
on

a \| SRE

Payo Ring
no alain

= not key Flomax.

Preop pupil dilation tes:
1. topleamide 1% gts x2,

Successfully Managing IFIS with OVDs

© Step 1: Studythe eye & warn patient,

Perform preop dilation test.

Step 2: Prepare the AC.

© Step 3: Create IFIS Soft Shell Bridge (SSB)

© Step 4

2 RL ENT |

Perform low flow, low turbulence surgery

16. Steve A Arshinoff MD FRCSC

OVD Stepladder Approach to IFIS

AAO 2014

Step 2: Preparing the AC for IFIS

1. Use IC xylo-phe & 2 x adrenaline in the bottle,
Acc. intracardiac 1:1,000 adrenaline / 500 cc BSS.

2. Long, tight incisions

prevent iris prolapse. —*

Intracameral Sympathomimetic Agents

Brent sue aah”

Am pales: ate 13 wih 055-1 Sar
meta

Chan 8)

3. phenephine 10% mins iltedins ess
proposed David Ale, chard Pacha

Bi ae |

Xylocaine -Phenylephrine
to facilitate cataract surgery

1 proposed:

Lundberg 8, BehndigA
Intracameral mydtatics in
phacoemulsification cataract
surgery.

JERS 2003; 29: 2366-71

used 0.1%phenylephrine ,

Intracameral Phenylephrine

© Dose sponse: Bei A Lundberg
a perece yes spero tion

ed pronfephnne BEL mimo 25% 406025 mi + 1 185$ 05%

17. Steve A Arshinoff MD FRCSC OVD Stepladder Approach to IFIS AAO 2014

IC xylo-phe IC xylo-phe: Why it works so well.

Add minim (0.3 cs) 10%, phenylephrine to 5 cc BSS in 6 oc
ace DICH PEER + Xylocaine: Completely paralyzes sphincter.
30874 due 1779

ne an + Phenylephrine: Aggressively stimulates dilator
Add 34 drops of above phenylephrine solution t

* Benefits: 1. Maximally enhances iris tone.
IC xylo-phe thru si 2. Great for all cataract cases.
sl pups dat to 89 mm in 1 3. Adequate for 90+ % IFIS cases.

Inject 0.1 cc IC xylo-phe under Assia
ere mm of pupil dation — |

IC xylo-phe
If you would like this
xylo-phe formulation
& use sheet, please
email me at:
[email protected]

18. Steve A Arshinoff MD FRCSC OVD Stepladder Approach to IFIS AAO 2014

Successfully Managing IFIS with OVDs Step 3: Create IFIS Soft Shell Bridge

© Step1: Study the eye & warn patient. Tamponade peripheral ris with Viscoat.

‘Perform preop da test Blockade & Bridge central AC with Healons,

* Step2: Prepare the AC. Lift HS away from IFIS SS Bridge

ant. capsule with BSS, |
© Step 3: Create IFIS Soft Shell Bridge (SSB) or xyio-phe. a

Keep capsulorhexis,
smaller than pupil

© Step 4: Perform low flow, low turbulence surgery.

PES Malyugin Ring, (or iris retractors) ee |

TSST € SSB Successfully Managing IFIS with OVDs

© Stepl: Studythe eye & warn patient,
Perform preop dilation test.

© Step 2: Prepare the AC.

© Step3: Create IFIS Soft Shell Bridge (SSB)

Tri-Soft Shell Technique Soft Shell Bridge 2 step 4: Perform low flow, low turbulence surgery.
o EEE Bis ers ee |

19. OVD Stepladder Approach to IFIS AAO 2014

Step 4... Performing Phaco with IFIS SS Bridge

Use low flow > low turbulence (Oil.
1. Arpfowrate"1525cc/min
2. Vacuum <250 mm He

3. Bottle height 75 cm above pt’ s head

Keep phaco and I/A tips deep to “rhexis.

lia Reinject HS (rarely Viscoat) as needed: (e a |

Summary: IFIS SS Bridge

Considerable variation in sensitivity to Flomax.

© Preop dilation test, phenylephrine a

IFIS SS Bridge enables safe, easy

management of most IFIS cases.

Reestablish the IFIS SSB

structure when necessary (HS)

Boris Malyugin's ring (MST) Thank you

(Fyodorov Institute Moscow) sre. aro uP rs
Wf Stove Modi SSEUST formulan as cita naar

EAN =

Successfully Managing IFIS with OVDs

© Step: Study the eye & warn patient,
Perform preop dilation test.

© Step2: Preparethe AC.
© Step 3: Create IFIS Soft Shell Bridge (SSB)
© Step 4: Perform low flow, low turbulence surge

Malyugin Ring (or iris retractors) rarely,