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Risk factors for intraoperative floppy iris syndrome: a meta-analysis

Poster Details

First Author: I.Chatziralli GREECE

Co Author(s):    T. Sergentanis   A. Jaulim   M. Moschos        

Abstract Details


To evaluate risk factors (current tamsulosin, alfuzosin, terazosin, doxazosin use, hypertension, diabetes mellitus) for intraoperative floppy iris syndrome (IFIS) in patients undergoing phacoemulsification cataract surgery.


1Department of Ophthalmology, University of Athens, Athens, Greece 2Department of Ophthalmology, Barts and the London NHS Trust, London, UK 3Department of Epidemiology, University of Athens, Athens, Greece


We made a systematic review of the literature concerning IFIS. All references of relevant reviews and eligible articles were also screened. Language restrictions were not used and data were extracted from each eligible study by two investigators working independently. 17 eligible studies (17,588 eyes) examining the association between IFIS and risk factors were included in the meta-analysis. The fixed-effects model (Mantel-Haenszel method), or the random effects (DerSimonian Laird) model, were appropriately used to calculate the pooled odds ratio (OR). Publication bias was appropriately assessed.


The pooled OR for IFIS after tamsulosin use was nearly 40-fold higher (or 16.5 at the alternative analysis) than that of alfuzosin i.e., the second alpha1-blocker in order of effect size. Alfuzosin and terazosin were also associated with IFIS with comparable ORs. IFIS was positively associated with hypertension (pooled OR=2.2, 95% CI: 1.2-4.2, fixed effects) but not with diabetes mellitus (pooled OR=1.3, 95% CI: 0.7-2.2, fixed effects).


This meta-analysis has highlighted a hierarchy concerning the role of alpha1-blockers in IFIS, pointing to an extremely sizeable effect size of tamsulosin. Alfuzosin, terazosin and doxazosin presented with comparable effect sizes. Hypertension, but not diabetes mellitus, emerged as a risk factor for IFIS. FINANCIAL DISCLOSURE?: No

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