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Intraoperative floppy iris syndrome (IFIS): epidemiology and clinical assessment
Session Title: Complex Cases and Surgery
Session Date/Time: Monday 07/10/2013 | 14:30-16:00
Paper Time: 14:30
Venue: Forum (Ground Floor)
First Author: : T.Wierzchowski POLAND
Co Author(s): : M. Wilczy?ski A. Synder W. Omulecki
To assess the incidence, identify medications and clinical features associated with IFIS in patients undergoing cataract surgery.
1st Department of Ophthalmology, Medical University of Lodz, University Barlicki Hospital No. 1, Lodz Poland.
The study of consecutive cataract patients operated between January and December 2011(616 eyes, 610 patients) was performed to assess incidence of IFIS and to determine medications associated with IFIS. Medical history, current and past medication use were collected at the time of admission. We used slit lamp adapted Optical Coherent Tomography sl-OCT to examine anterior segment of 155 eyes (154patients), to measure pupil diameter before and after use of mydriatic agent and iris thickness at the dilator muscle region(DMR-half of distance between the scleral spur and pupillary margin) and sphincter muscle region (SMR-0,75mm from the pupillary margin).
The overall incidence of IFIS in presence of full triad of characteristic intraoperative features was 4%(25/616 eyes).The highest 39% prevalence of IFIS was in patients exposed to Tamsulosin. In other medications prevalence of IFIS were: Finasteride 26%, Alfuziosin 20%,Doksazosin 18% and Karwedilol 12%. IFIS occurs statistically more often in patients exposed to Tamsulosin than Karwedilol(chi2=5,960; p<0,05). There was no statistical significance between other medications. Pupil diameter before and after use of mydriatic agent were significantly smaller in patients with IFIS versus patients without IFIS (1,90 ± 0,43 vs 2,16 ± 0,37; p<0,01; dilated diameter 4,90 ± 0,96 vs 5,70 ± 0,87; p<0,01).The SMR was similar in patients with and without IFIS (537,1±67,7 vs 520,6±72,4; p>0,05). Significantly thicker DMR was found in patients with IFIS versus patients without IFIS (409,9 ± 55,7 vs 448,6 ± 55,8; p<0,05).The presence of IFIS correlate with higher risk of operative complications (focal iris laceration, iris sphincter trauma, transient postoperative hypertension).
Patients treated for benign prostatic hypertrophy or hypertension may have increased risk of complications during cataract surgery due to presence of IFIS. Slit lamp adapted Optical Coherent Tomography sl-OCT is useful device to detect clinical features associated with IFIS preoperatively. Those findings are warning surgeon of the potential operating difficulties with IFIS.