IFIS and Small pupils

IFIS and Small pupils
Eyeworld Oct, 2016

AT A GLANCE
1. Patients who have used tamsulosin may experience IFIS
2. Ask patients preoperatively about therir use of tamsulosin as well as the herb saw palmetto
3. Special dilating mixes can assist with dilation in eyes at risk for IFIS
4. Use devices like the Malyugin ring or iris hooks as necessary

DILATING MIXES
1. epinephrine + lidocaine in fortified BSS
formula:
 a.) 0.025% Epi + 0.75% lido
2. preOp pladgets: 10% pheylephrine, 1% tropicamide, 2% cyclogyl and a NSAID
3. Inject a mix of 1.5% phenylephrine and 1% lidocaine

Shugarcaine
The recipe in whole cc quantities is 9 cc BSS Plus (Alcon), 3 cc 4% preservative-free lidocaine (Hospira) and 4 cc 1:1000 preservative-free, bisulfite-free epinephrine (American Regent).

 If wishing to make up a small quantity, the easiest way is to draw up 1 cc of non-preserved, 4% lidocaine into 3 cc of BSS Plus, which makes 4 cc of regular Shugarcaine. Then discard 1 cc of this mixture (or use it for a case just requiring intracameral anesthetic) and draw 1 cc of the above specified 1:1000 epinephrine, which yields 4 cc of epi-Shugarcaine, enough for at least two cases.

1cc lido + 3cc BSS=Shugarcaine
Discard 1cc of mixture(Shugarcaine) then add 1 cc of epinephrine=epi-Shugarcaine



MALYUGIN RING
1. Insert: engage the scroll farthest away from you first and the two side ones
2. Remove:  Use a second instrument to remove the ring, UNHOOK the DISTAL side first and work your way around in a circle
3. Remove the ring before removing the OVD



Dr. Yu-Hao Lin, MD
Deputy superintendent, Brand New Eye Clinic
http://www.eyeDrLin.tw