Iris ricochet sign: Indicator of peripheral extension of anterior capsulorhexis during femtosecond laser–assisted capsulotomy

Abstract

A 25-year-old man with history of electrocution presented with an intumescent cataract in the left eye and was scheduled for femtosecond laser–assisted cataract surgery. During delivery of the laser pulses for creation of the capsulotomy, leakage of milky intralenticular fluid was noted at multiple points, accompanied by an iris ricochet; that is, explosive outward displacement of the pupillary margin at the 3 o’clock position followed by a slower inward rebound. After the corneal incisions and capsule staining were opened with trypan blue dye, the anterior capsulorhexis margin was noted to be extending peripherally up to the equator at the site of the iris ricochet. This report highlights the possibility of peripheral extension of the anterior capsulorhexis margin during the creation of the femtosecond laser–assisted capsulotomy itself and emphasizes the importance of recognizing the iris ricochet sign as a possible indicator of this complication.