a-adrenergic receptor antagonists are used to relax smooth muscle of the lower urinary tract, for relief of symptoms of benign prostatic hyperplasia. They cause pupil hypotony (Parssinen 2005) ABSTRACT.Purpose: To compare 2% sub-Tenon and 1% intra-cameral lidocaine for cataract surgery in relation to the incidence and severity of IFIS. Prospective randomized clinical study. Methods: From 81 eligible, we included 71 men aged from 59 to 90 years (mean 76.5 ± 6.8) undergoing routine cataract surgery and taking oral aadrenergic antagonists, for urological reasons, for more than 1 year. Following randomization 34 men, aged from 62 to 90 years (mean 77.4 ± 8.1) received sub-Tenon injection of 2.5 ml of 2% lidocaine and the remaining 37 men aged from 59 to 89 years (mean 75.2 ± 7.2) received 1% preservative free intracameral lidocaine. Outcome measures were the incidence of IFIS, severity of intra-operative pupillary constriction and iris prolapse.Results: Intra-operative floppy iris syndrome (IFIS) was noted in 3 of 34 patients (8.8%) receiving sub-Tenon lidocaine and in 18 of 37 patients (48.6%) receiving intra-cameral lidocaine (p = 0.00). Severe IFIS was observed only in 3 of 37 patients (8.1%) receiving intra-cameral lidocaine. Pupil diameter at the end of surgery was 4.37 ± 1.07 mm in the sub-Tenon lidocaine group and 4.02 ± 1.06 mm in the intra-cameral lidocaine group (p = 0.00). Iris prolapse was noted in two cases in the sub-Tenon lidocaine group and in 10 cases in the intra-cameral lidocaine group (p = 0.00). Twenty-five patients were receiving tamsulosin. The incidence of IFIS in tamsulosin subgroup was 76.9% (10 of 13 patients) in the intra-cameral lidocaine group and 16.6% (2 of 12 patients) in the sub-Tenon lidocaine group (p = 0.00). Conclusion: Sub-Tenon lidocaine reduces significantly the incidence of IFIS in patients taking oral a-adrenergic inhibitors as compared with intra-cameral lidocaine.

Purpose To report safety and efficacy of intra‐operative injection of 2% lidocaine during small incision cataract surgery in cases of unexpected intra‐operative floppy iris syndrome. Methods 4 patients, undergoing routine cataract surgery, who were exposed to alfa‐adrenergic inhibitors, and it was not known pre‐operatively, and in whom intra‐operative floppy iris syndrome occurred unexpectedly. 2.5 ml of 2% lidocaine was injected into the sub‐Tenon space in response to intra‐operative iris prolapse and pupillary constriction. Injection was performed following hydrodissection in 3 of 4 cases and hollowing capsulorrhexis in 1 of 4 cases. The surgery was video‐taped from the beginning of the injection. Results No further iris prolapse was noted in any case, nor further pupillary constriction. Iris plane was stabilized. There were no further complications of cataract surgery. Patients were comfortable and pain free for the rest of the procedure. Conclusion Intra‐operative injection of 2% lidocaine into the sub‐Tenon space is a safe way of reversing iris floppiness and the tendency to iris prolapsed in cases of unexpected intra‐operative floppy iris syndrome. It is an alternative to other intra‐operative techniques to manage IFIS, which provides pain relief as well as iris stabilization.