J Korean Ophthalmol Soc.  2014 Jan;55(1):73-78.

Incidence and Risk Factors of Intraoperative Floppy Iris Syndrome During Cataract Surgery

• Park HG
• Choi S

Abstract

PURPOSE
To determine the incidence and risk factors of intraoperative floppy iris syndrome (IFIS) in patients undergoing cataract surgery.
METHODS
The present study included 981 eyes of 655 patients who underwent cataract surgery and development and grade of IFIS were recorded. Correlation analysis was performed to determine the relationship between the IFIS and risk factors such as alpha1-adrenergic antagonist (tamsulosin, terazosin, alfuzosin), benzodiazepine, 5-alpha-reductase inhibitor, age, gender, hypertension, diabetes and glaucoma.
RESULTS
IFIS developed in 178 eyes (18.1%) out of 981 eyes. There was a correlation between the development of the IFIS and alpha1-adrenergic antagonist and benzodiazepine and male gender; however, there was no correlation with 5-alpha-reductase inhibitor, age, gender, hypertension, diabetes and glaucoma. IFIS grade tended to be higher as the cumulative dosage of the alpha1-adrenergic antagonist increased. Odds ratio of the patients using tamsulosin was the highest among the other risk factors, which was 3.8 times higher than the patients using terazosin, 9.0 times higher than the patients using alfuzosin and 11.1 times higher than the patients using benzodiazepine. Among patients who underwent cataract surgery on both eyes and who were confirmed with IFIS in 1 or both eyes, no significant grade differences between the 2 eyes were noted.
CONCLUSIONS
Alpha 1-adrenergic antagonist and benzodiazepine were risk factors for the development of the IFIS, and as the cumulative dosage of the alpha1-adrenergic antagonist increased, the probability of developing a higher grade of IFIS increased. Therefore, predicting and preparing for potential IFIS in patients who have the above-mentioned risk factors are necessary before planning cataract surgery. Additionally, the IFIS aspect of the first eye could be utilized as a predictive value for developing IFIS profile of the fellow eye.

Keyword

Alpha 1-adrenergic antagonist; Benzodiazepine; Cataract surgery; Intraoperative floppy iris syndrome

MeSH Terms

Benzodiazepines
Cataract*
Glaucoma
Humans
Hypertension
Incidence*
Iris*
Male
Odds Ratio
Risk Factors*
Benzodiazepines

Reference

References

1. Chang DF, Campbell JR.Intraoperative floppy iris syndrome associated with tamsulosin. J Cataract Refract Surg. 2005; 31:664–73.

2. Bell CM, Hatch WV, Fischer HD. . Association between tam-sulosin and serious ophthalmic adverse events in older men follow-ing cataract surgery. JAMA. 2009; 301:1991–6.

3. Chang DF, Braga-Mele R, Mamalis N. . Clinical experience with intraoperative floppy-iris syndrome. Results of the 2008 ASCRS member survey. J Cataract Refract Surg. 2008; 34:1201–9.

4. Chatziralli IP, Sergentanis TN.Risk factors for intraoperative flop-py iris syndrome: a meta-analysis. Ophthalmology. 2011; 118:730–5.

5. Shin KH, Sohn HJ, Lee DY, Nam DH.A case of intraoperative flop-py iris syndrome in a patient using tamsulosin. J Korean Ophthalmol Soc. 2009; 50:1586–9.

6. Kim EK, Chung SK, Baek NH.The effect of α1-adrenergic blocker on phacoemulsification. J Korean Ophthalmol Soc. 2012; 53:256–61.

7. Blouin MC, Blouin J, Perreault S. . Intraoperative floppy-iris syndrome associated with alpha1-adrenoreceptors: comparison of tamsulosin and alfuzosin. J Cataract Refract Surg. 2007; 33:1227–34.

8. Settas G, Fitt AW.Intraoperative floppy iris syndrome in a patient taking alfuzosin for benign prostatic hypertrophy. Eye (Lond). 2006; 20:1431–2.

9. Venkatesh R, Veena K, Gupta S, Ravindran RD.Intraoperative floppy iris syndrome associated with terazosin. Indian J Ophthalmol. 2007; 55:395–6.

10. Michel MC, Okutsu H, Noguchi Y. . In vivo studies on the ef-fects of alpha1-adrenoceptor antagonists on pupil diameter and urethral tone in rabbits. Naunyn Schmiedebergs Arch Pharmacol. 2006; 372:346–53.

11. Nakamura S, Taniguchi T, Suzuki F. . Evaluation of alpha1-a-drenoceptors in the rabbit iris: pharmacological characterization and expression of mRNA. Br J Pharmacol. 1999; 127:1367–74.

12. Yu Y, Koss MC.Functional characterization of alpha-adreno-ceptors mediating pupillary dilation in rats. Eur J Pharmacol. 2003; 471:135–40.

13. Clarke RJ, Zhang H, Gamlin PD.Characteristics of the pupillary light reflex in the alert rhesus monkey. J Neurophysiol. 2003; 89:3179–89.

14. Wikberg-Matsson A, Uhlén S, Wikberg JE.Characterization of alpha(1)-adrenoceptor subtypes in the eye. Exp Eye Res. 2000; 70:51–60.

15. Neff KD, Sandoval HP, Fernández de Castro LE. . Factors as-sociated with intraoperative floppy iris syndrome. Ophthalmology. 2009; 116:658–63.

16. Chatziralli IP, Sergentanis TN, Papazisis L, Moschos MM.Risk factors for intraoperative floppy iris syndrome: a retrospective study. Acta Ophthalmol. 2012; 90:e152–3.

17. Calotti F, Steen D.Labetalol causing intraoperative floppy-iris syndrome. J Cataract Refract Surg. 2007; 33:170–1.

18. Takmaz T, Can I.Clinical features, complications, and incidence of intraoperative floppy iris syndrome in patients taking tamsulosin. Eur J Ophthalmol. 2007; 17:909–13.

19. Oshika T, Ohashi Y, Inamura M. . Incidence of intraoperative floppy iris syndrome in patients on either systemic or topical alpha(1)-adrenoceptor antagonist. Am J Ophthalmol. 2007; 143:150–1.

20. Santaella RM, Destafeno JJ, Stinnett SS. . The effect of alpha1-adrenergic receptor antagonist tamsulosin (Flomax) on iris dilator smooth muscle anatomy. Ophthalmology. 2010; 117:1743–9.

21. Prata TS, Palmiero PM, Angelilli A. . Iris morphologic changes related to alpha(1)-adrenergic receptor antagonists im-plications for intraoperative floppy iris syndrome. Ophthalmology. 2009; 116:877–81.

22. Zarbin MA, Anholt RR.Benzodiazepine receptors in the eye. Invest Ophthalmol Vis Sci. 1991; 32:2579–87.

23. Issa SA, Dagres E.Intraoperative floppy-iris syndrome and finasteride intake. J Cataract Refract Surg. 2007; 33:2142–3.

24. Wong AC, Mak ST.Finasteride-associated cataract and intra-operative floppy-iris syndrome. J Cataract Refract Surg. 2011; 37:1351–4.

25. Altan-Yaycioglu R, Gedik S, Pelit A. . Clinical factors associated with floppy iris signs: a prospective study from two centers. Ophthalmic Surg Lasers Imaging. 2009; 40:232–8.

26. Abdel-Aziz S, Mamalis N. Intraoperative floppy iris syndrome. Curr Opin Ophthalmol. 2009; 20:37–41.

27. Mirza SA, Alexandridou A, Marshall T, Stavrou P.Surgically in-duced miosis during phacoemulsification in patients with diabetes mellitus. Eye (Lond). 2003; 17:194–9.