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

Abstract

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.

Efficacy and Safety of an Intracameral Combination of Two Mydriatics and an Anesthetic for Phacoemulsification in Complicated Patients

“…According to the previous literature, diabetes causes neuropathy and vascular alterations which compromise pupillary dilation [10,11]. Moreover, therapies for hypertension and benign prostatic hypertrophy with alpha-adrenergic receptors antagonists invalidate the activity of pupil dilating muscle [12]. However, significant differences have not been observed in the reference group of this study.…”

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

“…56 A sub-tenon injection of 2.5mL of lidocaine 2.5% has also been reported to reduce all features of IFIS in mild-to-moderate cases. 57 Intracameral epinephrine and phenylephrine promote pupillary dilation and reduce iris floppiness. 58,59 They can be used either at the beginning of surgery for poorly dilated pupils (<4,5mm) or intraoperatively during progressive miosis where they can yield an additional 1mm of dilation.…”

Intraoperative floppy iris syndrome associated with silodosin

“…After 45 days, he stopped silodosin; he underwent cataract surgery. During the surgery, ophthalmologist reported the triad of IFIS and the patient needed surgical interventions, during cataract surgery in which surgeons also were allowed to use intraoperative prophylactic measures (Klysik & Korzycka 2014). To our best knowledge, this was the first case of IFIS by silodosin.…”