Lens–iris diaphragm retropulsion syndrome and iris hooks

We note with interest the article by Cionni et al.1 and the comments by Lee et al.2 with regard to lens–iris diaphragm retropulsion syndrome (LIDRS). In our experience, LIDRS in vitrectomized eyes occurs more often in myopic eyes than others. We use a single flexible iris retractor (Grieshaber) in risk cases. The retractor is placed at the 6 o'clock position (diagonally opposite the entry wound) at the beginning of the surgery. This has the advantage of equalizing the pressure between the anterior chamber (AC) and the vitreous cavity as soon as the infusion starts, negating the effect of any zonular laxity. It also prevents reverse pupillary block and consequent pressure rise. We have found this technique to be helpful in keeping the AC and the pupil stable and making postvitrectomy phacoemulsification less stressful.