The closer the wound is to the limbus, the higher the risk of iris (re)prolapse and anterior synechia formation.
If the prolapse is through a scleral wound, reposition is done via gentle pushing. If the IOP is high, the prolapse may recur; the assistant should in such cases hold the iris back with a spatula while the surgeon introduces the sutures (see Chap. 2.3). Injecting a strong miotic agent into the anterior chamber (AC) can also help keeping the iris from reprolapsing.
Time was once considered essential in determining whether the iris should be reposited or excised ("excision if extruded for over 24 h"). We now consider the iris' condition (see above) the decisive factor.
4 The same concentration should be used as for intravitreal injections (see Chap. 2.17).
5 Pushing is recommended only if the prolapse is very small.
6 Viscoelastics are used to keep the iris from reprolapsing, not to push the iris back into the AC.
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