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Management of intraoperative floppy-iris syndrome in cataract surgery: a randomised study

Poster Details

First Author: M.Weber AUSTRIA

Co Author(s):    S. Maedel   N. Hirnschall   P. Draschl   O. Findl     

Abstract Details



Purpose:

To evaluate the influence of a standard cohesive ophthalmic viscoelastic device (OVD) in comparison to a viscoadaptive OVD in eyes at risk of intra-operative floppy-iris syndrome on intra-operative complications, pupil size and post-operative inflammation.

Setting:

Vienna Institute for Research in Ocular Surgery, Department of Ophthalmology, Hanusch Hospital, Vienna

Methods:

This randomised trial included patients who were scheduled for cataract surgery and who have been taking alpha-1 adrenergic receptor antagonists such as tamsulosin. Eyes were allocated to a standard cohesive OVD (Healon, Abott Medical Optics, USA; control group), or a visco-adaptive OVD (Eyefill S.C., Croma Pharma, Austria; VA-OVD group) The OVD was used to stabilize the iris and viscodilate the pupil during phacoemulsification. The rescue strategy was the use of iris hooks in case of the pupil becoming too small. Intra-operative complications such as iris prolapse as well as pupil size during all steps of surgery were documented. Aqueous flare was measured pre-operatively, 1 hour, 1 day and 1 month post-operatively with the Laser Flare Meter FM-600 (Kowa, Japan). Additionally central corneal thickness (CCT) and intra-ocular pressure (IOP) were assessed.

Results:

Fourty eyes of 40 patients were included. The rate of phaco bites and iris prolapses was low and did not differ between the groups. In none of the eyes iris retractors had to be used. Pupil size before incision and after phacoemulsification in control group was 7.7 ± 1.3mm and 6.4 ± 1.7mm and in VA-OVD group was 7.4 ± 1.2mm and 5.3 ± 1.4mm. These differences were not found to be significant (p=0.53 and p=0.11). Mean aqueous flare 1 hour, 1 day and 1 month post-operatively in control group was 15.3 ± 14.2pc/ms, 6.5 ± 4.6pc/ms and 5.3 ± 4.4pc/ms and in VA-OVD group was 25.4 ± 32.8pc/ms, 9.1 ± 8.5pc/ms and 5.1 ± 3.3pc/ms. These differences were not found to be significant (p=0.25, p=0.29, p=0.89). Mean CCT 1 hour post-operatively in control group and in VA-OVD group was 573 ± 61µm and 598 ± 44µm, respectively (p=0.16). Mean IOP measured 1 hour post-operatively was 19 ± 7mmHg in control group and 20 ± 9 mmHg in VA-OVD group (p=0.81).

Conclusions:

In eyes at risk of intra-operative floppy-iris syndrome no significant difference in intra-operative pupil diameter, post-operative aqueous flare, CCT and IOP were found when using a standard cohesive OVD in comparison to the use of a viscoadaptive OVD. FINANCIAL INTEREST: NONE

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