Floppy iris syndrome and cataract surgery

Enright, Jennifer M.; Karacal, Hümeyra; Tsai, Linda

doi:10.1097/icu.0000000000000322

Cited by 37 publications

(28 citation statements)

References 49 publications

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“…1 Furthermore, controlling the iris mechanically, although sometimes effective, requires additional surgical time and increases the postoperative billowing. 53,55 Consequently, in cases at high-risk for IFIS, such as male population on tamsulosin with a poor mydriasis, pupil expansion devices are preferably used as a preventive measure from the beginning of surgery rather than after IFIS develops to avoid jeopardizing the integrity of the capsulorrhexis.…”

Section: Intraoperative Managementmentioning

confidence: 99%

“…55 On the other hand, pupil expansion devices are in most cases much easier to use, require less operating time, do not require extra incisions and provide a stable pupil during surgery minimizing postoperative pupil deformity and anterior chamber inflammation. [53][54][55] Healon5 ® OVD (Johnson & Johnson Vision, Santa Ana, CA) and other viscoadaptive/dispersive ophthalmic viscosurgical devices (OVDs) have been used as a mean for maintaining the pupil dilated intraoperatively. 47 Healon5 is generally preferred in cases where low fluidics are used as it can be aspirated easily.…”

Section: Intraoperative Managementmentioning

confidence: 99%

“…The most common dilution used is 1:3 with Balanced Salt Solution (BSS), resulting in a 1:4000 epinephrine solution. 55 It is preferable to use preservative-and bisulfite-free epinephrine and phenylephrine intracamerally. However, these solutions are not always available in the surgical setting and a recent study that was designed to evaluate the intracameral phenylephrine preparations protocols for dosage accuracy, concluded that current protocols are inaccurate and inconsistent, thus the concentration of phenylephrine delivered intracamerally is low and highly variable.…”

Section: Intraoperative Managementmentioning

confidence: 99%

“…Considering complications, their incidence is significantly higher in an unanticipated IFIS. 9,55 Complications related to IFIS may vary from mild and transient to detrimental including posterior capsule rupture, vitreous prolapse, retained lens fragments, iris trauma, wound dehiscence, nuclear drop, postoperative inflammation and intraocular hypertension among others. Fortunately, in verified highrisk patients where preventive measures are employed, complication rates return to their baseline values.…”

Section: Complicationsmentioning

confidence: 99%

“…69 The long-term consequences of a cataract surgery complicated with IFIS include permanent pupil deformity and vision loss secondary to endophthalmitis, macular edema or retinal detachment. 55…”

Section: Complicationsmentioning

confidence: 99%

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<p>Intraoperative Floppy Iris Syndrome: Updated Perspectives</p>

Christou¹,

Tsinopoulos²,

Ziakas³

et al. 2020

OPTH

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Almost fifteen years since its initial description, intraoperative floppy iris syndrome (IFIS) during phacoemulsification surgery remains a challenge for cataract surgeons in all its key aspects that include the stratification of the preoperative risk, preoperative prophylaxis treatment, surgery design and intraoperative management. Since its original association with tamsulosin intake, IFIS has been positively correlated with a plethora of risk factors which include: gender, age, hypertension, other a1-adrenergic receptor antagonists, finasteride, angiotensin II receptor inhibitors, benzodiazepines, antipsychotics, hypertension drugs and decreased dilated pupil diameter. The assessment and stratification of the preoperative risk is pivotal in screening patients prone to develop IFIS. For these patients, it is essential that preoperative prophylaxis, employment of necessary measures and surgical technique modifications are considered. A multidisciplinary approach of IFIS is a mandate, thus ophthalmologists, urologists and sometimes other specialties should cooperate to "educate" each other about the risks of their respective fields. They both must be aware of the joint statement on IFIS by the American Academy of Ophthalmology and the American Society of Cataract and Refractive Surgery which suggests either the initiation of tamsulosin after phacoemulsification or the use of a non-selective a1-ARA for benign prostatic hyperplasia treatment. In conclusion, awareness of the risk factors associated with IFIS and their detailed preoperative documentation is crucial in addressing IFIS. The lack of such an awareness can turn a routine, uneventful surgery into one with significant visual morbidity.

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Section: Intraoperative Managementmentioning

confidence: 99%

Section: Intraoperative Managementmentioning

confidence: 99%

Section: Intraoperative Managementmentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

See 3 more Smart Citations

<p>Intraoperative Floppy Iris Syndrome: Updated Perspectives</p>

Christou¹,

Tsinopoulos²,

Ziakas³

et al. 2020

OPTH

View full text Add to dashboard Cite

show abstract

Bilateral cataract surgery in a Japanese macaque (Macaca fuscata): A case report

Miwa

Komatsu

Shinojima

et al. 2021

Clinical Case Reports

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Survey of Ehlers‒Danlos Patients’ ophthalmic surgery experiences

Louie

Meyerle

Francomano

et al. 2020

Molec Gen & Gen Med

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Background: Ehlers-Danlos Syndrome (EDS) is a rare disease affecting approximately 1 in 5,000 people. Although ophthalmic conditions associated with EDS have been described, little data exist concerning ophthalmic surgical outcomes experienced by EDS patients. Methods: Patients with EDS were surveyed via the EDS Society and asked about their ophthalmic surgical experiences including procedure, complications, and the timing with respect to receiving the EDS diagnosis. Complications were confirmed as such by subspecialists. Results: Of 579 respondents, 467 reported confirmed EDS, and 112 of those had an ophthalmic procedure, including refractive surgery, cataract/lens surgery, retinal surgery, strabismus surgery, oculoplastic surgery, corneal surgery, and laser surgery for glaucoma. The rate of confirmed complications was: 23%-refractive, 33%-lens/ cataract, 33%-retina, 59%-strabismus, 23%-oculoplastics, 0%-cornea, and 25%-glaucoma laser. In addition, 76% of patients underwent surgery prior to the EDS diagnosis. Conclusions: Patients with EDS may have elevated risk of postoperative ophthalmic surgical complications. It would seem reasonable to systemically and prospectively explore how patients with EDS respond to ophthalmic surgery. Furthermore, it would seem circumspect to ask surgical candidates patients about whether they carry a diagnosis of EDS or have signs and symptoms of EDS prior to surgery.

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Floppy iris syndrome and cataract surgery

Cited by 37 publications

References 49 publications

<p>Intraoperative Floppy Iris Syndrome: Updated Perspectives</p>

<p>Intraoperative Floppy Iris Syndrome: Updated Perspectives</p>

Bilateral cataract surgery in a Japanese macaque (Macaca fuscata): A case report

Survey of Ehlers‒Danlos Patients’ ophthalmic surgery experiences

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