Factors Associated with Intraoperative Floppy Iris Syndrome

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

“…Although IFIS may have a multifactor etiology, systemic treatment with an a 1 -ARA seems to play a pivotal role. 11,12 The association between tamsulosin and IFIS has been confirmed in numerous studies, 5,[13][14][15] as has the fact that IFIS may occur in patients taking other a 1 -ARAs. 11,13,[16][17][18][19][20] In the 2008 American Society of Cataract and Refractive Surgery (ASCRS) IFIS survey, 21 95% of experienced surgeons reported that systemic treatment with the a 1 -ARA tamsulosin makes cataract surgery more difficult and leads to higher rates of complications.…”

“…This also points to the need to identify all risk factors involved in IFIS. 8,12 In high-volume cataract surgery units, especially those with less experienced surgeons, IFIS prediction and recognition are especially important. 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.…”

“…21 Drugs that have been associated with IFIS include saw palmetto, an herbal supplement used for BPH; finasteride; antipsychotic drugs; and some b-blockers with particular a-blocking properties. 12,21,[32][33][34][35] Other drugs that might induce iris dilator smooth-muscle relaxation include endothelin-A antagonists, angiotensin antagonists, and nitric oxide donor compounds. 8,11 Certain systemic diseases, such as diabetes, hypertension, and congestive heart failure, can affect intraoperative iris behavior.…”

“…8,11 Certain systemic diseases, such as diabetes, hypertension, and congestive heart failure, can affect intraoperative iris behavior. 11,12 Schwinn and Afshari 11 hypothesize that because of the complexity of signaling pathways in the iris, a 1 -ARAs are merely the beginning of our understanding of IFIS and that a constellation of factors more complex than previously thought affects the causes of IFIS.…”

“…It is therefore conceivable that undocumented use of saw palmetto could be the cause in IFIS cases with no clearly associated factors. 8,12 Moreover, the possibility cannot be excluded that the patients who had IFIS in the control group could have been exposed to tamsulosin in the past but they had no accurate memory to report to the investigators. The rate of complications in this study was within the limits previously reported for high-volume experienced surgeons and similar to the reported rate after standard phacoemulsification with IOL implantation.…”