<p>Intraoperative Floppy Iris Syndrome: Updated Perspectives</p>

Abstract

Almost fifteen years since its initial description, intraoperative floppy iris syndrome (IFIS) during phacoemulsification surgery remains a challenge for cataract surgeons in all its key aspects that include the stratification of the preoperative risk, preoperative prophylaxis treatment, surgery design and intraoperative management. Since its original association with tamsulosin intake, IFIS has been positively correlated with a plethora of risk factors which include: gender, age, hypertension, other a1-adrenergic receptor antagonists, finasteride, angiotensin II receptor inhibitors, benzodiazepines, antipsychotics, hypertension drugs and decreased dilated pupil diameter. The assessment and stratification of the preoperative risk is pivotal in screening patients prone to develop IFIS. For these patients, it is essential that preoperative prophylaxis, employment of necessary measures and surgical technique modifications are considered. A multidisciplinary approach of IFIS is a mandate, thus ophthalmologists, urologists and sometimes other specialties should cooperate to "educate" each other about the risks of their respective fields. They both must be aware of the joint statement on IFIS by the American Academy of Ophthalmology and the American Society of Cataract and Refractive Surgery which suggests either the initiation of tamsulosin after phacoemulsification or the use of a non-selective a1-ARA for benign prostatic hyperplasia treatment. In conclusion, awareness of the risk factors associated with IFIS and their detailed preoperative documentation is crucial in addressing IFIS. The lack of such an awareness can turn a routine, uneventful surgery into one with significant visual morbidity.

Anesthesia Considerations for Cataract Surgery in Patients with Schizophrenia: A Narrative Review

“…There has been a report of borderline association between the antipsychotic agent (quetiapine) and intraoperative floppy iris syndrome, in line with its antagonistic action on alpha-adrenergic receptors ( 33 ). Intracameral adrenaline and phenylephrine, often used to reduce iris floppiness ( 34 ), may cause hypertension, especially in patients taking monoamine oxidase inhibitor or tricyclic antidepressant ( 35 ).…”

A transcriptome atlas of the mouse iris at single cell resolution defines cell types and the genomic response to pupil dilation

“…An important iatrogenic disorder, intraoperative floppy iris syndrome (IFIS), occurs during ~2% of cataract surgeries and is a risk factor for surgical complications (Enright et al, 2017;Christou et al, 2020). IFIS is characterized by pupil constriction, a flacid and billowing iris, and prolapse of the iris through the surgical incision.…”

A narrative review of intraoperative floppy iris syndrome: an update 2020

“…However, the overall effect of these medicines in comparison with tamsulosin is less significant due to their difference in receptor affinity. Besides additional technical difficulty in phaco surgery, exposure to tamsulosin within 14 days of cataract surgery significantly increases serious postoperative complications, including loss of entire lens or lens fragment, retinal detachment or endophthalmitis (11). There are specific recommendations reached through survey and consensus among urologists.…”

“…Review Article on Recent Developments in Cataract Surgery pseudoexfoliation syndrome and glaucoma, hypertension, diabetes mellitus, 5α-reductase inhibitors and other α adrenoceptor antagonist such as silodosin, alfuzosin, doxazosin, and several neuromodulators (2,(7)(8)(9)(10)(11)(12). The occurrence of unanticipated IFIS is accompanied by increased rates of multiple complications, including corneal endothelial loss, iris trauma, anterior capsule tears, posterior capsule rupture (PCR), retained nuclear fragments, vitreous loss, macular edema and postoperative ocular inflammation (1,13).…”