Iris prolapse; who? When? Why?

A 12-month period was reviewed to identify the incidence of iris prolapse following cataract surgery, and any predisposing factors. Of 1408 routine manual extracapsular cataract extractions, 29 eyes (2.06%) sustained an iris prolapse. Iris prolapse was commoner in Asian patients and when less experienced surgeons were operating. Twenty-five per cent of cases occurred in patients with obstructive airways disease or post-operative cough. Thirty-four per cent of iris prolapses were identified on the first post-operative day and 86% within 2 weeks. Prolapse probably occurs because of raised intraocular pressure in association with poor wound construction or closure. More emphasis should be given to wound construction and closure during surgical training, with extra diligence when operating on patients likely to cough postoperatively. Clinicians must ensure non-English speaking patients understand about ocular aftercare following cataract surgery.