Pharmacologic prophylaxis and risk factors for intraoperative floppy-iris syndrome in phacoemulsification performed by resident physicians

Abstract

The incidence of IFIS was lower than previously reported. Use of prophylactic intracameral lidocaine-epinephrine did not reduce the incidence of IFIS. A preoperative dilated pupil diameter smaller than 6.5 mm was significantly associated with an increased incidence of IFIS.

Pharmacologic pupil dilation as a predictive test for the risk for intraoperative floppy-iris syndrome

“…These factors, together with the surgeon's subjective perception of the degree of severity of IFIS, especially in mild cases, may help explain the widely variable incidences and severity of IFIS reported in the literature. 3,21,22 With respect to IFIS prediction by pharmacologically dilated pupil size, such a possibility seems viable on the basis of our results. In general, preoperative and postoperative measurements taken with computerized pupillometer or calipers appear to be inversely related to the incidence and severity of IFIS.…”

“…In a study of cataract extractions performed by resident physicians, the reported incidence of posterior capsule rupture and vitreous loss was 7.4% in patients taking tamsulosin compared with 1.8% in patients not taking tamsulosin. 22 Even for experienced surgeons, the rate of vitreous loss during cataract surgery in patients taking tamsulosin ranges from 0.6% for high-volume surgeons to 7.0% and 12.0% in United States and United Kingdom surveys, respectively. 1,13,21,22 However, when IFIS is anticipated and proper management strategies are used, the outcome is favorable and the complication rate is low for both skilled surgeons and residents.…”

“…22 Even for experienced surgeons, the rate of vitreous loss during cataract surgery in patients taking tamsulosin ranges from 0.6% for high-volume surgeons to 7.0% and 12.0% in United States and United Kingdom surveys, respectively. 1,13,21,22 However, when IFIS is anticipated and proper management strategies are used, the outcome is favorable and the complication rate is low for both skilled surgeons and residents. 3,22,25 The present study found no difference in pupil diameter under mesopic conditions between patients on tamsulosin, patients on another a 1 -ARA, or patients on no a 1 -ARA.…”

“…1,13,21,22 However, when IFIS is anticipated and proper management strategies are used, the outcome is favorable and the complication rate is low for both skilled surgeons and residents. 3,22,25 The present study found no difference in pupil diameter under mesopic conditions between patients on tamsulosin, patients on another a 1 -ARA, or patients on no a 1 -ARA. This may be due to the complexity of the biology of the aging iris in which multiple factors affect pupil functionality and could overcome the a 1 -ARA effect.…”

“…3,8 Rather than regarding IFIS as a rare, unexpected, and unpredictable syndrome attributed to 1 drug, IFIS predisposition should be predictable via careful evaluation of pupil size behavior. A recent study by Chen et al 22 found that a preoperative dilated pupil diameter smaller than 6.5 mm was significantly associated with an increased incidence of IFIS in patients taking tamsulosin.…”