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Prediction of intraoperative floppy iris syndrome (IFIS) in patients with oral selective alpha 1A receptor antagonists

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Session Details

Session Title: Cataract Surgery Special Cases

Session Date/Time: Monday 09/10/2017 | 14:30-16:00

Paper Time: 14:36

Venue: Meeting Center Room I

First Author: : R.Varsits AUSTRIA

Co Author(s): :    M. Weber   J. Hienert   B. Doeller   K. Kefer   O. Findl        

Abstract Details


The „intraoperative floppy iris syndrome“ (IFIS) can occur to varying degrees under peroral therapy with alpha 1A receptor blockers. It can lead to a progressive pupil constriction and thus increase the complication risk of a cataract operation. The aim of this study was to predict the incidence and severity of IFIS using various pre-operative parameters such as pupil dilation after mydriatics, the iris thickness in the dilatator muscle region in patients receiving selective alpha 1A receptor antagonists and in control patients.


Vienna Institute for Research in Ocular Surgery (VIROS), Hanusch Hospital, Vienna


50 patients with a planned cataract surgery who had either received a selective alpha-1A receptor blocker (group A) or no history of alpha-1A receptor blocker therapy (control group B) were included. The iris thickness in the dilatator muscle region (DMR) was measured by OCT. The preoperative pupil size in mydriasis
(PM) after administration of tropicamide 0.5% and phenylephrine 10% eye drops was measured. Additionally, the intraoperative iris deflectability (IAL) was measured. All these were correlated with the pupil size at the end of surgery.


The mean pupil size at the end of the operation was 6.6±1.2mm in group A statistically significantly smaller than group B with 7.6±0.9mm (p=0.05). The averaged thickness of the DMR was 269±73μm and 283±43μm, respectively (p=0.76). The PM was 5.8±1.0mmand 5.9±0.8mm, respectively (p=0.82). The IAL was 0.60±0.39mm and 0.39±0.24mm, respectively (p=0.20). The correlation of the pupil size at the end of surgery with the DMR was low (r²=0.16; p=0.68), with the PM was moderate (r²=0.48; p=0.01) and with the IAL was low (r²=-0.30; p=0.15).


The incidence of IFIS and its severity is difficult to predict. The thickness of the dilator muscle region is hardly different between the groups and do not appear to be good predictors of the occurrence of IFIS. The preoperative pupil size after administration of mydriatics is also not significantly different between the groups, but appears to be a moderately good predictor of the occurrence of IFIS.

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