Avoiding iris trauma from phacoemulsification in eyes with iridoschisis

Iridoschisis is a rare condition frequently associated with age-related cataract. Phacoemulsification can be difficult to perform in these eyes, as the detached iris fibrils that are typically present free float in the anterior chamber and are attracted to the phaco tip and the irrigation/aspiration handpiece port. We describe a technique for performing phacoemulsification in eyes with iridoschisis. In this technique, iris fibrils are held in place by 2 ophthalmic viscosurgical devices (OVDs) that are injected into the inferior portion of the anterior chamber. An elliptical capsulorhexis is made and limited to the superior half of the pupil for additional stability of the anterior chamber during surgery. The nucleus is chopped with a phaco chopper and a bent-tip, 22-gauge needle. Most of the phacoemulsification is performed under the anterior capsule. The iris comes into contact with the OVDs only and has no mechanical trauma.