Fluid-structure interaction in phaco-emulsification based cataract surgery

Cataract scatters the light as it enters the eye, blurs images and severely interferes people's daily activities. The only effective therapy is cataract surgery, in which the clouded lens is phacoemulsified and removed. However, an aberrant iris distortion, namely intra-operative floppy iris syndrome (IFIS), is not uncommon in the phacoemulsification process, and it greatly degrades the surgical outcomes. Despite its great impact, the mechanism of IFIS has seldom been explored from the mechanics viewpoint. This study constitutes the first exploration into IFIS mechanism within the torsional-irrigation/aspiration (T -I/A) combined mode, from the perspective of fluidstructure coupling, employing our newly developed fluid-structure interaction (FSI) simulation framework. The impacts of several factors, including probe type and position, irrigation and aspiration (I/A), iris stiffness and lens presence, are evaluated in two different torsional-irrigation/aspiration (T -I/A) combined configurations, corresponding to the scenarios of coaxial and bimanual I/A operations. Results reveal that by altering the probe's location in anterior chamber, three distinct modes of iris dynamics are recognized and defined as repulsion (RP), attraction (AT), and adhesion (AH) modes according to the relative iris-probe location. Among them, RP mode, where the iris is repelled by the probe, is preferred to ensure the safety of the iris. Furthermore, IFIS could be alleviated by stiffening iris, reducing I/A strength and choosing coaxial I/A device. These interventions result in the contraction of the damaging AH zone towards the iris root, occurring at approximately one-fourth (coaxial case), one-fifth (coaxial case), and one-fourth of the iris length, achieved by quadrupling iris stiffness, ceasing I/A flow, and utilizing coaxial I/A device, respectively. However, the risk of IFIS is only marginally impacted by the lens presence. Our findings gain a deeper insight into the iris dynamics in T -I/A mode from fluid-iris interaction viewpoint, which may provide valuable guidance for the surgical protocol operation.