Cataract Surgery Difficult Cases

APRIL 2010 I CATARACT & REFRACTIVE SURGERY TODAY EUROPE I 31 T he incidence of wound gape or iris prolapse after cataract extraction reportedly ranges from 0% to 1.6% with phacoemulsification and 0% to 3% with extracapsular cataract extraction.1 Contemporary cataract surgery is most commonly performed through sutureless clear corneal incisions with a wound width of 3.2 mm or less. These small wounds improve surgical safety, cause fewer complications, decrease trauma to ocular structures, lower induced astigmatism, and require less surgical time compared with larger incisions. There have been few isolated reports of iris prolapse following small clear corneal incision cataract surgery.2-4 Postoperative iris prolapse warrants further surgical intervention such as wound reconstruction and iris repositioning or iridectomy to avoid persistent wound leakage, endophthalmitis, and epithelial ingrowth. In this article, we describe a case of external cystic epithelial ingrowth complicating traumatic wound failure with long-standing iris prolapse 4 months after small self-sealing clear corneal incision phacoemulsification. We review treatment and prevention of this new and rare complication of modern phacoemulsification.