Lecture Notes: Management of Coral Tear with Iris Prolapse

Introduction

• Location: Ranaghat, West Bengal, India
• Topic: Management of coral tear with Iris prolapse

Surgical Process

• Thorough irrigation of ocular surface with BSS (Balanced Salt Solution) and Moxyflasin.
• Iris prolapse occurs through the corneal wound.

Important Considerations

• Iris Not Repositioned Immediately:
  • Contact with ocular surface bacteria can lead to infection if not handled properly.
  • Upsizing the iris is crucial to prevent bacteria from entering the anterior chamber.

Surgical Steps

1. Side Port Creation:

   • A side port is created for anterior chamber lavage post-surgery.
   • Viscoelastic substance (Visco) is injected into the anterior chamber for better management.

2. Upsizing the Iris:

   • The iris is carefully upsized using visco to avoid inclusion in the wound.
   • Initially attempted a shoeless continuous suture but switched to interrupted sutures.
   • Suture type: 10 o nylon.

3. Suture Placement:

   • Each suture helps to reposition the iris and is placed with visco aid.
   • Followed a pattern of three loops for securing the suture.
   • Threads cut close to the knot and buried in the corneal stroma.

4. Additional Sutures:

   • Multiple interrupted sutures placed to ensure stability.
   • Bites taken to 80% depth for adequate grip.
   • All sutures should have optimum tension: not too tight or loose.

5. Final Sutures:

   • Additional interrupted suture placed at the end of the corneal wound.
   • Triangular flap of cornea is supported by sutures.

6. Exudate Removal and Lavage:

   • Important to remove visco and any exudates from the anterior chamber.
   • Use of Sinskey hook and spatula to manage iris incarceration.

Final Steps

• Clear lens at the time of surgery but may become opaque later.
• Hydration of side port to avoid needing additional sutures.
• Anterior chamber lavage conducted to ensure cleanliness.
• Moxyflasin drops applied to cornea post-surgery.

Conclusion

• Surgery duration was about 23 minutes, condensed to a 12-minute video presentation.
• Importance of careful management in repairing coral wounds highlighted.
• Encouragement for viewers to learn from the presented surgical techniques.