J Korean Ophthalmol Soc.  2019 Jan;60(1):32-39. 10.3341/jkos.2019.60.1.32.

The Effect of Preoperative Homatropine for Intraoperative Floppy Iris Syndrome in Patients Taken Alpha Blockers

• Moon HS
• Choi JH
• Ko BY
• Yoon KC

• KMID: 2431837
• DOI: http://doi.org/10.3341/jkos.2019.60.1.32

Abstract

PURPOSE
To investigate the effects of homatropine eye drops before cataract surgery to prevent intraoperative floppy iris syndrome (IFIS) in patients treated with alpha blockers.
METHODS
The medical records of 98 eyes from 68 patients taking alpha blockers who underwent cataract surgery were retrospectively reviewed and divided into three groups: patients with preoperative instillation of homatropine (group 1), patients with preoperative instillation of atropine (group 2), and patients without preoperative eye drops (group 3) for three days. Age, sex, underlying disease, type of alpha blocker, preoperative and postoperative pupil size, parameters of phacoemulsification, surgical complication, and the degree of IFIS of patients were measured to compare among the three groups.
RESULTS
No significant differences were found in age and underlying diseases. Significant differences were found in the preoperative and postoperative pupil size, cumulative dissipated energy, and the incidence rate of iris prolapse through the incision sites among the three groups, but no significant difference was detected in other findings, or with regard to intraoperative or postoperative complications. In addition, the preoperative pupil size and preoperative instillation of 1% atropine were significant factors for decreasing the degree of IFIS.
CONCLUSIONS
Preoperative instillation of homatropine as well as atropine before cataract surgery minimized the degree of IFIS in patients taking alpha blockers. In addition, the pupil size recovered more rapidly after surgery in the homatropine group than in the atropine group.

Keyword

Alpha blocker; Cataract; Homatropine; Intraoperative floppy iris syndrome

MeSH Terms

Atropine
Cataract
Humans
Incidence
Iris*
Medical Records
Ophthalmic Solutions
Phacoemulsification
Postoperative Complications
Prolapse
Pupil
Retrospective Studies
Atropine
Ophthalmic Solutions

Figure

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  Figure 1. Calculation of the intraoperative pupil size. The pupil size was calculated with the ratio of the horizontal length of the pupil (*) and the length between the limbus of cornea (†) compared with the preoperative horizontal diameter of the cornea. Intraoperative pupil size = (*, mm)/(†, mm) × pre-operative corneal diameter.

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  Figure 2. Distribution of the use of α-blockers among three group. Tamsulosin made up the largest number of α-blockers in all the groups.

Reference

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