My 8 point strategy to deal with IFIS - Dr Deepak Megur

[@rashiray471]

Yesterday I did a case of grade4 NS suspecting IFIS. Went through your video multiple times before surgery. God! I sailed through smoothly. Thank you for being such a great teacher.

[@mariosmp77]

I am very grateful to you for your generosity in sharing your experiences with the world!! Thank very much!!

[@NetoRosatelli]

What an excellent video, dear Deepak! Very comprehensive, many tips to deal with this challenging situation. Superb! 👏👏👏😊

[@DrDeepakMegur]

Thank you Dr Neto

[@hepaticapropria]

Omg 👏🏼👏🏼👏🏼👏🏼 those cases are so complicated 😢 first case was marvelous!

[@asrasaleha7405]

Thank you sir..did one suspected IFIs non dilating pupil phaco today..Ur video helped immensely.each and every tip works perfectly . thank you once again.

[@Surgeonshand87]

Beautiful narrative , great and helpful video pearls to do IFIS

[@kenlagunzad]

Did one today. This works. Thanks Dr Megur.

[@dr.c.apprabhu429]

What a great teaching video. Your meticulous thinking and planning are just unbelievable

[@DrDeepakMegur]

Glad you think so!

[@mguerramd]

Just before hydrodissecting I remove a bit of viscoelastic to just see the chamber go down a bit, evidenced by the cornea slightly dimpling down. Now I have just a bit more leeway to hydrodissect before the iris prolapses. Every time I need to do another hydrodissection wave, I stop and slightly decompress the chamber first. It helps. And frankly, I have learned that no matter how big the pupil is before the start, if the patient is on Tamsulosin, it WILL be trouble. So I just always put in iris hooks period. If you decide to put hooks after the capsulotomy, it's easy to hook the capsule along with the iris. It's easy and fast to just avoid all trouble, insert four hooks before the capsulotomy, and get the case done! I have been burned too many times thinking " Oh, maybe this one will go well, the pupil is up nicely" Nope, it's ALWAYS trouble.

[@sushma6511]

All important points well demonstrated Sir. plz make a video on how to go behind the iol and wash.

[@drmukeshkumar73]

Wonderful demonstration Sir Thank you so much 👍

[@mostafaaggour3993]

Congrats for beautiful presentation It’s nice tip avoiding second instrument all the time even I do cracking with help of nucleons cracker I don use atropine as I think paralyzing the sphincter is the target but enhancing dilator pupillary ms is more important Low bottle Low aspiration rate Single hand emulsification So impressive teaching video

[@vivek96100]

Excellent surgery sir. I learn new tips from your every video.

[@ozlemyazar6825]

Thank you sir 🙏

[@janzada3373]

Excellent and very informative...

[@muazzamcmc]

Very helpful.. I am yet to come across any video with such meticulous planning for IFIS... thanks alot sir...

[@Amos_Kiptoo]

Megur, this is excellent

[@thiru1501]

absolutely fantastic sir

[@sereyvathleang7758]

It’s a very helpful video 💕. Thank Dr.Deepak Megur

[@revatichavan7676]

This is definitely going to be helpful. .. very useful tips . Thank you for sharing sir Wonderful surgery

[@situmapw8219]

Thanks for sharing

[@alimabbasali7418]

Fantastic sir God bless you Great thanks for sharing this wonderful experience

[@choi2275]

Not long ago, I had a similar experience. It's a very helpful video. Thank you.

[@deepikakhurana5601]

Very informative video! Thank you sir!

[@MohammedKhoudrani]

great teachings...

[@ejv1963]

Have you tried intracameral Mydrane or preservative free 2.5% Phenylephrine?

[@mathieuriviere9254]

placing iris hooks under incisions prevents iris prolapse and then you can go for a routine surgery

[@arturocapulong]

sir may i ask what kind of chopper are you using?

[@emirgorcevic2599]

thanks for detailed explanation

[@dr.rajeshyadav7504]

Very good sir

[@TheSaurav3]

Is b hex better than iris hooks in these cases Sir

[@gundolfwestphal]

Thank you for these tips and tricks! May I ask whether Phenyleprine is an adequate alternative to atropine prior to the surgery? Have you had any experience with it?

[@drbalramkhanotiyaeyesurgeo9630]

Thank you so much sir 🙏🙏

[@preetikamat9554]

Very good tips.Extremely useful. Thank you Sir

[@sandiprane9571]

Thank you sir it helps me lot

[@musawerjaved3562]

Excellent presentation sir. I simply use diluted ADR intracameral in IFIS which helps me alot. BTW these steps may help further.

[@ardeidaxhamuca3582]

Hello what dilution for intracameral adrenaline please?

[@musawerjaved3562]

@@ardeidaxhamuca3582 i dilute 1mg/ml in 4 ml BSS

[@almazfeleke8811]

It is helping us thank you

[@dr.jahidurrahman237]

Thanks a lot.when to start & how times of atropine drops before surgery?

[@DrDeepakMegur]

1 drop b d for 2 days prior to surgery

[@mehmetkay271]

Thank you sir.Why do phaco in the anterior plan?

[@drashutosheye]

Sir which rhexis forcep is used in this case and what's the size of globe fixation ring ?

[@zuhairyassin505]

Is tamsulosin the only culprit in this syndrome ?

[@Dr.alejandroruelas]

Hi! I loved your video, i just have one doubt: isn't there any problem with a dilated pupil post operatively because of the atropine? Or you just instill pilocarpine once the case is done and the atropine doesn't have a longer lasting effect?

[@DrDeepakMegur]

Hi, i don't use pilo post op, It won't work. But most of the patients don't complain much about the mididilated pupil which stays for about 8- 10 days. Pre op counseling is important . Thank you

[@Dr.alejandroruelas]

@@DrDeepakMegur Thanks a lot!

[@AKSHAY00024]

Excellent presentation sir!! IFIS can be the worst nightmare for the cataract surgeon! I have a question sir, do you dilute the trypan blue dye before using? Anterior capsule in your videos is very nicely stained and it remains so till the end of surgery. In my case dye usually washes of during phaco! Thank you.

[@DrDeepakMegur]

i dont dilute. try keeping the dye for 15 seconds before irrigation it might last longer.

[@AKSHAY00024]

@@DrDeepakMegur thank you sir!!!

[@drvanashreenair679]

Excellent explanation and demonstration of how to manage known and possible ifis cases. your tips about:smaller and longer incision size, dispersive ovd, anterior plane of emulsification, Lower infusion pressure ,helped me to avoid iris prolapse in a known patient on tamsulosin, since the pupil was moderately dilated to begin with, carefully following above tips helped me to avoid iris prolapse, didnt need hooks which i had kept standby. My previous experiences with cases which turned out to be ifis intraop, using the iris hooks, helped me to enlarge the pupil and stabilise it better, but prolapse of iris tissue had caused some damage in both sics and phaco cases. your simple and clear explanation is worth ingraining for every surgeon.thank you for the efforts you put in for benefit of all.

[@DrDeepakMegur]

Glad you found it helpful

[@alimabbasali7418]

I ask when to use cohesive and dispersive ovd

[@dr.abdulbasirsafi5051]

Very good

[@leilagouvea]

Hi, dr. Megur. I'm a brasilian doctor and I 'll present a talk about floppy iris . could I share your video in my presentation mentioning you?

[@DrDeepakMegur]

Please go ahead and use it with reference.

[@vamshinaga7465]

Sir at the beginning of the video there was iris prolapsing out. How did u manage that case ?

[@DrDeepakMegur]

ok let me post that csae ,

[@vamshinaga7465]

@@DrDeepakMegur Ok . Thank you sir 👍

[@moneyoil4082]

Q. did not using cycloplegic eyedrop for routine case ?? use only selective case??

[@DrDeepakMegur]

Tropicamide +phenylephrine for routine cases

[@kipkapper3014]

i just do not like spinning of the lens , i really see very very little upside. its traumatic to the capsule and really not necessary, the lens will free itself up rather easily with hydro and normal surgical manipulation. having said that your talent is exceptional.

[@dr.swapnilpatil1154]

Hello sir, What to do if IFIS is intraoperative surprise and the iris is coming out from all the ports....

[@DrDeepakMegur]

Strategies- Low pressure surgery-low bottle height , dispersive ovd, Intra cameral Adrenaline. If nothing works, use IRIS HOOKS> That s the last resort but works very well.

[@jayashreegaddi5567]

Super sir , tq

[@cooldudemikeen]

Sir where can I procure rhexis forceps used in the video ? Which company ?

[@DrDeepakMegur]

Epsilon india

[@cooldudemikeen]

@@DrDeepakMegur thank you sir

[@janzada3373]

Sir are you using adrenalin in BSS in routine cases?

[@DrDeepakMegur]

no, i dont

[@janzada3373]

Are you using BSS or ringer?

[@DrDeepakMegur]

BSS

[@janzada3373]

@@DrDeepakMegur thanks

[@dr.abdulbasirsafi5051]

Very good