ESCRS - PP11.18 - Is Preoperative Mydriasis Indicative Of Intraoperative Floppy Iris Syndrome? A Multivariate Analysis

Is Preoperative Mydriasis Indicative Of Intraoperative Floppy Iris Syndrome? A Multivariate Analysis

Published 2025 - 43rd Congress of the ESCRS

Reference: PP11.18 | Type: Free paper | DOI: 10.82333/kber-8h40

Authors: Ana Sofia Martins* 1 , Bruno B. Ribeiro 1 , João Heitor Marques 1 , Ana Carolina Abreu 2 , Sílvia Monteiro 2 , Maria Céu Pinto 1

1Ophthalmology,ULS Santo António,Porto,Portugal, 2Ophthalmology,ULS Santo António,Porto,Portugal;Instituto de Ciências Biomédicas Abel Salazar (ICBAS) - School of Medicine and Medical Sciences,Porto,Portugal

Purpose

The study's objective was to examine how dilated pupil diameter (PD) may serve as a risk factor for the development of Intraoperative Floppy Iris Syndrome (IFIS) and its relationship with complications during and after cataract surgery.

Setting

2nd Department of Ophthalmology

Aristotle University of Thessaloniki

Papageorgiou General Hospital

Thessaloniki, Greece 

Methods

A total of 1178 cataract patients, were identified and included in a multivariate cross-sectional analysis at a tertiary care ophthalmic center. Each case had a thorough preoperative documentation of potential predisposing risk factors for the occurrence of IFIS, and pupil size was assessed one week before surgery after maximum pharmacologic dilation.

Results

In a study of 1,294 eyes undergoing cataract surgery, IFIS was noted in 44 cases, amounting to 3.4%. The preoperative pupil diameter (PD) was significantly lower in patients who developed IFIS (PDIFIS=6.23±1.4mm compared to PDNON-IFIS=7.38±0.9mm, p<0.001), and this significant difference persisted among patients using a1-blockers for benign prostatic hyperplasia (PD IFIS=5.86±1.5mm vs PD NON-IFIS=6.78±0.9mm, p=0.01). Pupil diameter was found to have a negative correlation with rates of posterior capsular rupture and iris trauma (p=0.03 and P<0.001 respectively). A cut-off value of 6.8mm in all patients and 6mm in patients taking a1 blockers was found indicative of predicting the appearance of IFIS with high sensitivity and specificity,

Conclusions

The degree of pupillary dilation before surgery appears to play a crucial role in the appearance of floppy iris and may serve as a predictive indicator for surgeons to help reduce the possible severe outcomes of unexpected IFIS.