Intraoperative floppy iris syndrome in Indian population: A prospective study on incidence, risk factors, and impact on operative performance

Abstract

Purpose:The purpose of this study was to evaluate the incidence, risk factors, and impact of intraoperative floppy iris syndrome (IFIS) on surgical performance.Materials and Methods:Consecutive cataract surgeries from October 2010 to Feb 2011 (1003 eyes, 980 patients; 568 males, 412 females) were analyzed prospectively. Operating surgeon, masked about medication history, noted the intraoperative details. Cases were identified as IFIS or non-IFIS. Multivariate analysis was performed to find risk factors for IFIS.Results:Prevalence of tamsulosin use among men undergoing cataract surgery was 7.0% (41) with incidence of IFIS 4.78% (48). On multivariate analysis, hypertension (OR: 3.2, 95% confidence interval, 95% CI: 1.39-6.57; P = 0.005), use of tamsulosin (OR: 133.32, 95% CI: 50.43-352.48; P < 0.0001), or alfuzosin (OR: 9.36, 95% CI: 2.34-37.50; P = 0.002) were the factors associated with IFIS. Among men taking tamsulosin (n = 41) and alfuzosin (n = 28), 68.3% and 16.6% developed IFIS, respectively. In subgroup analysis of men on tamsulosin, no factor added to the risk posed by tamsulosin. Seventeen of 944 eyes not exposed to any drug had IFIS (0.018%). On subgroup analysis, only risk factor for IFIS was hypertension (OR: 4.67, 95% CI: 1.63-13.35; P = 0.002). Of 48 IFIS eyes, the surgeon observed increased difficulty in 57.1% (21) and additional measures were required in 9 eyes. Mean operative time was increased in IFIS eyes (11.68 ± 3.46 vs. 10.01 ± 0.22 min; P = 0.001). Surgical outcome was good in all cases.Conclusion:The prevalence of tamsulosin intake and IFIS incidence is higher in India. Current tamsulosin/alfuzosin use and hypertension are important risk factors. IFIS makes the surgery more difficult, significantly prolongs the operative time, and predisposes for other intraoperative complications. However, with appropriate management, final operative outcome is not affected.

Risk factors for intraoperative floppy iris syndrome: a prospective study

“…Our results confirm the findings of previous studies and isolated case reports. 6,[10][11][12][13][14][15][16][17][18][19]23,25,30,31 It is worthy to mention that tamsulosin was found to be the most significant factor independently associated with IFIS. Noticeably, the OR for tamsulosin was significantly higher than that regarding alfuzosin or terazosin.…”

“…3,5 Previous studies have reported an association between IFIS and intake of α-blockers, which are commonly used for the treatment of benign prostatic hyperplasia. Specifically, IFIS was independently associated with tamsulosin, 1,6-10 doxazosin, 2,9,11 terazosin, 12 alfuzosin, 8,10,13 silodosin, 14 or labetalol, a selective α-and β-blocker. 15 Interestingly, a meta-analysis of the risk factors for IFIS demonstrated a hierarchy in the magnitude of the associations between the various α-blockers and IFIS.…”

“…23 Apart from potential association with the intake of various medications, IFIS has been also noted in patients with hypertension. 10,16,30 However, most of the published studies examining risk factors for IFIS are retrospective. In addition, as the awareness about IFIS becomes larger, the syndrome is more likely to be detected and various risk factors will be confirmed.…”

Clinical risk factors associated with intraoperative floppy iris syndrome: a prospective study

“…Tamsulosin may also selectively block alpha1A-ARs in the iris dilator muscle, inhibiting mydriasis during surgery, which can be a concern for ophthalmologists. Since 2005, the relationship between IFIS and non-selective alpha1-ARAs, hypertension, and male sex has been also reported [1][2][3]. An association between IFIS and other medications such as finasteride, mianserin, rivastigmine, antipsychotic drugs, and benzodiazepines has also been described [3][4][5].…”

“…The influence of finasteride use in both monotherapy and combined therapy on the development of IFIS is still unclear. The overall prevalence of IFIS in the study by Chang and Campbell was 2%, but later studies found an even higher incidence, reaching up to 12.6% [2,3,[7][8][9][10]. The occurrence of IFIS during cataract surgery may induce intraoperative complications including posterior capsule rupture, capsulorhexis tear, iris trauma, zonular dialysis, vitreous prolapse, and corneal edema, and thereby the identification of the risk factors for IFIS is particularly important for surgeons [9].…”