Use of Narrow Calibrated Side-Port Technique to Prevent Occurrence of Intraoperative Floppy Iris Syndrome During Phacoemulsification Surgery.

Purpose: To describe the use of a narrow calibrated side-port incision technique in preventing Intraoperative Floppy Iris Syndrome (IFIS).

Setting: Dr Om Parkash Eye Institute, Amritsar, India.

Design: Prospective interventional study.

Methods: Four hundred and fifty eyes of patients using alpha-1 antagonist drug Tamsulosin were included in the study. Phacoemulsification surgery was performed with a calibrated side-port incision integrated to the existing preferred techniques in patients taking Tamsulosin. Our technique involved creating a narrow 500 microns (µm) side-port incision, paired with a differentially calibrated chopper shaft measuring 400 to 450 µm, with a 50 µm variation along the shaft. This precise calibration between the side-port and chopper sizes minimized fluid leakage, preventing surgical impediments and side-port wound distortion. The reduced fluid efflux through the side-port incision stabilized the anterior chamber near the side port, decreased iris contact with the chopper and eliminated the risk of iris prolapse. Integration of side-port calibration into the existing techniques helped prevent IFIS from developing around the side-port incision site.

Results: Our technique of calibrated side-port incision, which requires perfect calibration of the incision with the chopper, gave excellent results. Our study comprised of a total of 450 eyes from patients on Tamsulosin undergoing phacoemulsification were included. IFIS was completely absent in 271 eyes. Minimal IFIS, characterized by iris billowing, was observed in 179 eyes, while no cases of moderate or severe IFIS occurred.

Conclusion: When added to existing surgical techniques, a calibrated side-port incision significantly improves patient outcomes in managing IFIS during phacoemulsification in patients taking alpha-1 antagonist drugs. This modification helps prevent the side-port incision from becoming a focal point for IFIS, thereby enhancing surgical safety and efficacy.