The issue of IFIS in cataract surgery

David F Chang MD The first paper describing intraoperative floppy iris syndrome (IFIS) was published in 2005. Providing an update on this topic, David F Chang MD, Los Altos, California, United States, reviewed what has been learned about the causes and management of IFIS. There is good evidence that IFIS is more likely to occur in patients who are using the “uroselective” alpha 1A-selective alpha-blocker tamsulosin, compared with non-selective alpha-blockers. Although there is a pharmacological explanation for the difference, results of a prospective masked comparative study assessing IFIS severity show that between the two uroselective alpha 1A-selective alpha-blockers that are used for the treatment of benign prostatic hypertrophy (BPH), the risk of severe IFIS with tamsulosin is about double that with alfuzosin. To prevent IFIS, Dr Chang encouraged the use of a mechanical device to hold the pupil open and not to count on pharmacologic management with the addition of phenylephrine to the irrigating solution, particularly in patients with a small pupil who appear to be at the greatest risk for severe IFIS. Citing findings of surveys showing that physicians who prescribe uroselective alpha-blockers for treatment of BPH are often unaware that these agents can lead to significant complications during cataract surgery, or do not ask their patients about eye conditions, Dr Chang also reminded attendees to take a careful medication history in men who will be having cataract surgery. “We cannot rely on the prescribing physicians to help us out,” he said.