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

Casuccio, Alessandra; Cillino, Giovanni; Pavone, Carlo; Spitale, Emanuela Rosaria; Cillino, Salvatore

doi:10.1016/j.jcrs.2011.02.030

Cited by 48 publications

(37 citation statements)

References 37 publications

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“…These findings are consistent with the fact that patients with tamsulosin treatment develop progressive intraoperative pupillary miosis during cataract surgery [2,3,10]. In contrast, Casuccio et al found that pupil diameter was significantly smaller both preoperatively and postopoperatively in patients taking tamsulosin compared with their control group, however both exclusion criteria and their mydriatic regimen were different [27]. …”

Section: Discussionsupporting

confidence: 74%

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Comparing the efficacy of mydriatic cocktail-soaked sponge and conventional pupil dilation in patients using tamsulosin – a randomized controlled trial

et al. 2013

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BackgroundA strong association exists between the use of tamsulosin and the occurance of intraoperative floppy iris syndrome. Several methods were advocated to overcome the progressive intraopertive miosis.Our purpose was to investigate the effect of a mydriatic-cocktail soaked cellulose sponge on perioperative pupil diameter in tamsulosin-treated patients undergoing elective cataract surgery.MethodsPatients using tamsulosin were dilated either with mydriatic-cocktail soaked sponge (group 1) or with conventional eyedrop regimen (group 2). Control patients not taking any α1 adrenergic receptor inhibtors were also dilated with mydriatic sponge (group 3).In all groups oxybuprocain 0.4%, cocain 4%, tropicamide 1%, phenylephrine 10%, diclophenac 0.1% along with chloramphenicol 0.5% were used preoperatively.Pupil diameter (mm) was measured preoperatively, after nucleus delivery, and before IOL implantation. Adverse effects associated with the use of sponge, minor and major intraoperative complications, the use of iris retractors and operation time were recorded.Differences in general between groups were analyzed with a one way analysis of variance (ANOVA); differences between groups in proportions were assessed by Fisher’s exact test.ResultsMean pupil diameter (mm) was preopertively: 7.52 ± 1.21, 7.30 ± 1.55 and 7.99 ± 0.96 (ANOVA: p = 0.079); after nucleus delivery: 6 ± 1.20, 6.29 ± 1.12 and 6.52 ± 0.81 (ANOVA: p = 0.123); before IOL implantation: 5.46 ± 1.06, 5.83 ± 1.09 and 6.17 ± 0.89 (ANOVA: p = 0.0291).No adverse effect related to sponge use was detected. Frequency of minor complications, and iris hook use was similar in the two tamsulosin treated group. Operation time did not differ significantly in the three groups.ConclusionWe have found that using a mydriatic cocktail-soaked wick – an alternative way to achieve intraoperative mydriasis for cataract surgery – was as effective and safe as the conventional repeated eyedrops regiment for tamsulosin treated patients.Trial registrationCurrent Controlled Trials ISRCTN37834752

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Section: Discussionsupporting

confidence: 74%

“…History of tamsulosin use among patients undergoing cataract surgery was estimated around 3% in the United States [25-27]. Although several pre- and intraoperative methods are used to overcome this problem, IFIS remains one of the pitfalls of cataract surgery.…”

Section: Discussionmentioning

confidence: 99%

Comparing the efficacy of mydriatic cocktail-soaked sponge and conventional pupil dilation in patients using tamsulosin – a randomized controlled trial

et al. 2013

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“…Another study by Casuccio et al prospectively grouped 150 patients into 3 equally distributed groups: 1 taking tamsulosin for at least a year, 1 taking another a 1A -ARA for at least a year, and a control group never on a a 1A -ARA. 12 In the tamsulosin group, 29 cases (58%) of IFIS were identified. Using a pupillary dilation cutoff of 7 mm, IFIS was able to be predicted with a 73% sensitivity and a 95% specificity (P = 0.001).…”

Section: Discussionmentioning

confidence: 99%

“…Both studies demonstrated an increased risk of IFIS with pupil dilation of < 6.5 or 7 mm, respectively. 12,13 The purpose of our study was to determine if a pharmacological test could be developed to determine iris dysfunction in patients taking tamsulosin, by isolating the selective adrenergic effects of 2.5% phenylephrine. We further examined if there exists a progression of smooth muscle dysfunction with duration of treatment.…”

Section: Introductionmentioning

confidence: 99%

The Differential Pupillary Response to 2.5% Phenylephrine in Patients Taking Tamsulosin

Hillelsohn

Liu

Hymowitz

et al. 2015

Journal of Ocular Pharmacology and Therapeutics

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“…Less than full pupillary dilatation is also good predictive factor for IFIS (Casuccio et al 2011); therefore, we aimed to select for the study patients with less than full pupillary dilatation on the preoperative assessment.…”

Section: Discussionmentioning

confidence: 99%

Sub‐Tenon injection of 2% lidocaine prevents intra‐operative floppy iris syndrome (IFIS) in male patients taking oral α‐adrenergic antagonists

Kłysik

Korzycka²

2013

Acta Ophthalmologica

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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.

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

Abstract: PURPOSE:To evaluate the effect of a1-adrenergic receptor antagonists (a1-ARAs) on pupil diameter and determine whether the diameter predicts intraoperative floppy-iris syndrome (IFIS).

Cited by 48 publications

References 37 publications

Comparing the efficacy of mydriatic cocktail-soaked sponge and conventional pupil dilation in patients using tamsulosin – a randomized controlled trial

Comparing the efficacy of mydriatic cocktail-soaked sponge and conventional pupil dilation in patients using tamsulosin – a randomized controlled trial

The Differential Pupillary Response to 2.5% Phenylephrine in Patients Taking Tamsulosin

Sub‐Tenon injection of 2% lidocaine prevents intra‐operative floppy iris syndrome (IFIS) in male patients taking oral α‐adrenergic antagonists

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