Prevalence And Clinical Risk Factors Of Intraoperative Floppy Iris Syndrome In Women: A Prospective Study
Published 2026 - 44th Congress of the ESCRS
Reference: FP09.08 | Type: Free paper | DOI: 10.82333/zbc1-wz22
Authors: Dr Irem Onal* 1 , Dr Mehmet Emin Gozel 2 , Dr Fahri Onur Aydin 2 , Dr Yusuf Berk Akbas 2 , Dr Ali Ceylan 3 , Dr Kerem Davulcu 2 , A/Prof. Burcin Kepez Yildiz 2
1Ophthalmology ,Basaksehir Cam and Sakura City Hospital ,Istanbul,Türkiye;Ophthalmology ,Sarikamis State Hospital,Kars ,Türkiye, 2Ophthalmology ,Basaksehir Cam and Sakura City Hospital ,Istanbul,Türkiye, 3Ophthalmology ,Basaksehir Cam and Sakura City Hospital ,Istanbul,Türkiye;Ophthalmology ,Akdeniz University,Antalya,Türkiye
Purpose
To evaluate the risk factors for intraoperative floppy iris syndrome (IFIS) in female patients undergoing cataract surgery
Setting
A prospective single-center study performed at a tertiary ophthalmology clinic, including female patients who underwent unilateral cataract surgery
Methods
This study included 704 female patients undergoing cataract surgery. IFIS was defined intraoperatively. Preoperative systemic comorbidities (diabetes mellitus, hypertension, and thyroid disorders), prior surgical history (ocular, cardiovascular, abdominal, and gynecological), medication use, trauma history, urinary incontinence, and glaucoma were recorded. Ocular parameters, including pupillography, anterior chamber depth (ACD), and iris color, were evaluated. Univariable and multivariable logistic regression analyses were performed to identify independent predictors. A parsimonious model was used as the primary analysis, and an expanded model as the secondary analysis. Postoperative outcomes were compared between IFIS and non-IFIS groups.
Results
IFIS developed in 37 eyes (5.3%). In univariable analysis, a history of gynecologic surgery was significantly associated with IFIS (OR 2.71; p=0.005). Light-colored iris showed borderline associations (p=0.063). In the primary multivariable model, gynecologic surgery (OR 2.92; 95% CI 1.45–5.88; p=0.003) and increasing age (OR 1.04 per year; 95% CI 1.00–1.08; p=0.034) were independently associated with IFIS. In the expanded model, gynecologic surgery remained strongly associated (OR 3.64; p=0.001), and age remained significant (p=0.023). Other systemic diseases, medications, pupil diameter, and ACD were not independently associated. IFIS was significantly associated with an increased intraoperative suture requirement (p<0.001).
Conclusions
In this prospective cohort of female patients, a history of gynecologic surgery was independently associated with an approximately threefold increased risk of IFIS. These findings suggest that prior gynecologic surgery may represent an underrecognized risk factor for IFIS in women undergoing cataract surgery.