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Comparison and differences in the appearance of intraoperative floppy iris syndrome between males and females

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Session Details

Session Title: Cataract II
Session Date/Time: Saturday 27/02/2016 | 08:30-11:00
Paper Time: 09:48
Venue: Trianti Room
First Author: : A.Tzamalis GREECE
Co Author(s): :    M. Samouilidou   M. Dermenoudi   E. Anastasopoulos   N. Chalvatzis   S. Dimitrakos   I. Tsinopoulos

Abstract Details


To compare the incidence of intraoperative floppy iris syndrome (IFIS) between male and female patients undergoing phacoemulsification cataract surgery, evaluate risk factors for its appearance in each gender and assess any differences on the final visual outcome.


2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece


Cataract patients with a recorded IFIS of any severity occurring over the last 4 years (March 2011 to February 2015) in a tertiary care ophthalmic centre during phacoemulsification surgery were identified through search in the electronic OP-recording software and enrolled in a multivariate analysis. Their medical records were retrospectively thoroughly reviewed and, when needed, patients were contacted again to gather further information regarding medication being taken at the time of surgery and contemporary ophthalmic status. Ophthalmic pathologies, clinical data on systemic health status and medications were evaluated as possible risk factors.


IFIS was observed in 25 out of totally 1937 eyes(1.29%) of 1678 female patients,whilst the incidence of IFIS in male patients was statistically significantly higher(5.17%,97/1874 eyes,p<0.0001). Twelve bilateral male and no bilateral female cases were recorded.Alpha1-receptor blockers intake was identified in 72.2% of male IFIS cases and in no female cases(p<0.0001).Current use of angiotensin-receptor antagonists and benzodiazepines were independently associated with IFIS in females(p<0.001).Posterior capsular rupture(PCR) incidence and final best corrected visual acuity correlated positively with the IFIS severity grade only in female patients(p=0.03). PCR rate was significantly higher in female IFIS patients(28%) than in male patients(9.28%,p=0.02).


Intraoperative floppy iris syndrome, although rarer in female in comparison to male patients, should not be disregarded, as its appearance may significantly increase intraoperative complications rate and affect the final visual outcome. Predisposing factors for the appearance of IFIS may differ between genders. Alpha receptors intake for benign prostatic hyperplasia in male and medical management of arterial hypertension and anxiety disorders with AT1-receptor antagonists and benzodiazepines respectively in female patients may lead to IFIS, highlighting the need of drug history awareness and preparation so that the surgeon may be allowed to employ appropriate compensatory measures to tackle IFIS.

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