Intraoperative floppy iris syndrome (IFIS) 30-month observational study of 2705 consecutive cataract operations
Janusz Adamski, Mariusz Doroszkiewicz, Sebastian Szaach, Magdalena Bryk- Siniarska, Agnieszka Nicpo
Ophthalmology Department of the State Hospital in Elblg
State Hospital in Elblg
IFIS in 2005, Chang and Campbell described a new condition characterized by 3 intraoperative features: flaccid iris stroma that undulates and billows in response to intraocular fluid currents, a propensity for the floppy iris stroma to prolapse toward the phacoemulsification and side-port incisions despite proper wound construction), progressive intraoperative pupil constriction despite standard preventive preoperative pharmacologic measures.
IFIS is characterized by preoperative small pupil.
IFIS classification according to Chang and Campbell:0 points - no IFIS symptoms, in spite of using the tamsulosine (Flomax) preparation,1 points - floppy iris stroma toward the phacoemulsification,2 points - floppy iris stroma and stroma prolapse toward the phacoemulsification and side-port incisions despite proper wound construction, 3 points - floppy iris stroma, stroma prolapse toward the phacoemulsification and side-port incisions despite proper wound construction and progressive intraoperative pupil constriction.
50% of males over 50 suffer from BPH*90% of males over 85 suffer from BPH
Pharmacological treatment: alpha-adrenergic blockersselective alpha- 1A /tamsulosine = Flomax/ 24xnon-selective alpha- 1A /eg. doxazosine; alphuzosine/In the urinary system, alpha- 1A adrenergic receptors prevail.
Nakamura- rabbit and rat iris the retractor muscle of the pupil contains over 90% of adrenergic receptors with alpha- 1A characteristics
*BPH- benign prostatic hyperplasia
Tamsulosine (Flomax) uro-selective iris-selective
Poor receptor blocking of the pupil retractor muscle may cause atrophy of that muscle and IFIS even after discontinuing the tamsulosine preparation.
Purpose:
To analyze the prevalence and severity of IFIS in a cataract phacoemulsification surgery population.
Material and method:
CATARACT OPERATIONS from 2 November 2005 to 30 April 2008 (30 months)W- women *- IOL fixation in ciliary groove M- men
W(1)M(2) W+ M(1+2) FACO+ PCIOL161410912705 99,45%FACO022 0,07%ECCE+ PCIOL7 2 (1*)9 0,33%ECCE314 0,15%2720 100%
Results:
* - incidental, sectional iris aspiration with aspiration tip, incl. pigment flushingT in interview - treated with TAMSULOSINE
IFIS classification acc. to CHANG & CAMPBELLWomenMenIntraoperative activitiesTIntraoperative activities1 point1515 -279 24 3 A2 points32 A1 rt136 5 1 A* 7 rt3 points11 -55 2 1 A 2 A+ rt1945
IFIS and benign prostatic hyperplasia /BPH/ therapyM* Tamsulosine 5 M Doxazosine 2 M Alphuzosine 5 M in the past treated /for BPH/ with unknown preparations
*M- men
standardrt- 1 corneo-scleral interrupted suture A- intracameral adrenaline
IFIS- TAMSULOSINE
IFIS classification acc. to CHANG & CAMPBELLFrom interview -men using TAMSULOSINEIntraoperative activities1 point9 8 1 rt2 points6 3 2 rt 1 A+ rt3 points5 2 1 A 2 A+ rt20
IFIS - DOXAZOSINE standardrt- 1 corneo-scleral interrupted suture A- intracameral adrenaline
IFIS classification acc. to CHANG & CAMPBELLFrom interview -men using DOXAZOSINEIntraoperative activities1 point44 2 points11 rt3 points--5
IFIS- ALPHUZOSINE standardrt- 1 corneo-scleral interrupted suture A- intracameral adrenaline
IFIS classification acc. to CHANG & CAMPBELLFrom interview -men using ALPHUZOSINEIntraoperative activities1 point2 1 1 A2 points- -3 points- -2
IFIS- BPH THERAPY WITH UNKNOWN PREPARATIONS standardrt- 1 corneo-scleral interrupted suture A- intracameral adrenaline
IFIS classification acc. to CHANG & CAMPBELLFrom interview -men using UNKNOWN PREPARATIONSIntraoperative activities1 point5 4 1 A2 points- -3 points- -5
Conclusions:
In the study presented, IFIS features were manifested in 2.37% of patients undergoing cataract facoemulsification surgery and related to 4.12% of men and 1.18% of women. IFIS could be an important cause to modify intraoperative procedures in cataract facoemulsification surgery.
