Management of Intraocular Floppy Iris Syndrome (IFIS) in Cataract Surgery

Storr‐Paulsen, Allan

doi:10.5772/52328

Cited by 3 publications

(3 citation statements)

References 27 publications

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“…The ophthalmic surgeon must be informed about the risk group of patients to be able to prevent the development of a severe IFIS by modifying the surgical technique 11,15,16. During the surgery, it is generally recommended to minimize in-and-out movements through corneal incisions, use low-flow irrigation/aspiration parameters, perform gentle hydrodissection, and keep the irrigation flow above the iris plateau 5,17 . An often preferred and reliable technique is the instillation of phenylephrine or epinephrine into the anterior chamber at the beginning and during the surgery 16 , Lorente et al confirmed the ability of phenylephrine to induce more pronounced mydriasis and restore iris rigidity 18 . An alternative -1% atropine drops twice a day for one week -can be chosen in the preoperative period 19 .…”

Section: Surgical Technique Modificationmentioning

confidence: 99%

“…It is often the drug of first choice due to its rapid onset of action 2 . It is also used as an antihypertensive (currently to a limited extent), and its effectiveness in the treatment of LUTS in women has also been reported 16,25 . Tamsulosin has recently been used in expulsive pharmacotherapy in distal ureterolithiasis, increasing the probability of the stone passing spontaneously by relaxing the tone of the smooth muscle of the ureter 26 .…”

Section: Selective Alpha-blockersmentioning

confidence: 99%

“…However, a prospective study by Chang et al from 2007 demonstrates that preoperative discontinuation of tamsulosin cannot fully prevent or reduce the severity of IFIS (ref. 16,39 ). In addition, this approach can lead to significant patient discomfort associated with micturition problems 11,12,65 .…”

Section: Non-selective Alpha-blockersmentioning

confidence: 99%

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Floppy iris syndrome associated with specific medication intake: A narrative review

Malušková¹,

Vidlář²,

Marešová³

et al. 2023

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Intraoperative floppy iris syndrome (IFIS) is a cataract surgery complication that remains a challenge for eye surgeons. It is caused by the antagonism of alfa-1-adrenergic receptors within the dilator muscle of the iris, thus preventing the iris from dilation during a cataract surgery. The long-term blocking alfa-1 adrenergic receptors by the chronic use of a number of systemic medications may lead to permanent anatomical atrophy of the dilator muscle of the iris. The most common drugs associated with the development of IFIS are tamsulosin and other alpha-1 adrenergic receptor antagonists prescribed to patients with low urinary tract symptoms (LUTS). There are other systemic medications that have been reported to have increased risk for IFIS. It is crucial for the ophthalmologist to identify the high-risk patients prone to develop IFIS. Its presence may complicate the course of cataract surgery, ultimately negatively affecting visual outcome. Cataract surgery should be performed by an experienced eye surgeon using alternative pharmacological and surgical techniques. Interdisciplinary cooperation is essential to mitigate potential complications. Patients should be informed by their physicians about the need to report a medication history to their eye specialists, especially before cataract surgery.

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Section: Surgical Technique Modificationmentioning

confidence: 99%

Section: Selective Alpha-blockersmentioning

confidence: 99%

See 1 more Smart Citation

Floppy iris syndrome associated with specific medication intake: A narrative review

Malušková¹,

Vidlář²,

Marešová³

et al. 2023

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Fluid-structure interaction in phaco-emulsification based cataract surgery

Wang,

Zhao

et al. 2024

International Journal of Mechanical Sciences

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The effect of orally administered glycerol on anterior chamber depth during cataract surgery in eyes with narrow anterior chambers

Nissen

Jørgensen

Nørregaard

et al. 2020

Acta Ophthalmologica

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Purpose Cataract surgery on eyes with shallow anterior chambers may be demanding. Glycerol intake prior to surgery has been a well‐known method in an effort to increase anterior chamber depth. It is used since it is thought that glycerol as an osmotic agent causes the vitreous body to shrink, pulling back the iris and thereby deepening the anterior chamber – making the surgery easier. Our controlled clinical trial tests this hypothesis and investigates the effect of glycerol on anterior chamber depth (ACD), intraocular pressure (IOP), corneal thickness (CCT), pupil diameter change after viscodilation (PD), operating time and perioperative complications. Methods We performed a controlled clinical trial. All patients underwent cataract surgery on both eyes with at least 7 days apart. Preoperatively the patient was given glycerol orally when the right eye was operated – when the left eye was operated, nothing was given. In this way, each patient was serving as its own control. Measurements of ACD, IOP and CCT were performed before and after glycerol intake, pupillary diameter was measured before and after viscoelastics during the operation, and operating time and surgical complications were noted. Results The study included 22 patients with bilateral cataract and anterior chambers depth <2.5 mm. Glycerol caused the anterior chamber to increase by 0.022 mm (p < 0.05), and IOP was lowered by 5.1 mmHg compared to the control group (p < 0.05). However, exposure to glycerol showed no effect on CCT, pupillary dilation of viscoelastics, operating time or surgical complications. Conclusion Glycerol increases anterior chamber depth and lowers intraocular pressure significantly. These changes had no significant impact on operating time nor on the complication rate, suggesting that these changes are too subtle to have a clinical impact on the cataract procedure.

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Management of Intraocular Floppy Iris Syndrome (IFIS) in Cataract Surgery

Cited by 3 publications

References 27 publications

Floppy iris syndrome associated with specific medication intake: A narrative review

Floppy iris syndrome associated with specific medication intake: A narrative review

Fluid-structure interaction in phaco-emulsification based cataract surgery

The effect of orally administered glycerol on anterior chamber depth during cataract surgery in eyes with narrow anterior chambers

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