Intraoperative floppy iris syndrome in Indian population: A prospective study on incidence, risk factors, and impact on operative performance

Purpose: The purpose of this study was to evaluate the incidence, risk factors, and impact of intraoperative floppy iris syndrome (IFIS) on surgical performance. Materials and Methods : Consecutive cataract surgeries from October 2010 to Feb 2011 (1003 eyes, 980 patients; 568 males, 412 females) wer...

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Published in:	Indian journal of ophthalmology Vol. 62; no. 8; pp. 870 - 875
Main Authors:	Goyal, Shilpa, Dalela, Deepansh, Goyal, Neeraj, Chawla, Shobhit, Dhesi, Rajat, Kamboj, Bela, Dalela, Abha
Format:	Journal Article
Language:	English
Published:	India Medknow Publications 01-08-2014 Medknow Publications and Media Pvt. Ltd Medknow Publications & Media Pvt. Ltd Medknow Publications & Media Pvt Ltd Wolters Kluwer Medknow Publications
Subjects:	Acromegaly Adrenergic alpha-1 Receptor Antagonists - adverse effects Axial length elongation Best-corrected visual acuity body stature growth Capsular Cardiovascular disease Cataract Cataracts central corneal thickness Confidence intervals dehiscence Dexamethasone Diabetes Diabetic retinopathy Distribution Eye diseases Eye surgery Family medical history Female floppy iris syndrome foldable intraocular lens Humans Hypertension Incidence India - epidemiology Indian eyes injector implantation inner segment/outer segment junction intraocular pressure Intraoperative Complications - chemically induced Intraoperative Complications - epidemiology Iris Diseases - chemically induced Iris Diseases - epidemiology lifestyle Male Middle Aged Multivariate analysis myopia nonmydriatic imaging optic disc topography Original outer retinal corrugation phacoemulsification Phacoemulsification - adverse effects Population Prospective Studies retinal nerve fiber layer thickness rhegmatogenous retinal detachment Risk Factors scleral fixation screening Studies Sulfonamides - adverse effects Surgery Surgical outcomes tamsulosin triamcinolone acetonide Cataract floppy iris syndrome tamsulosin phacoemulsification
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Summary:	Purpose: The purpose of this study was to evaluate the incidence, risk factors, and impact of intraoperative floppy iris syndrome (IFIS) on surgical performance. Materials and Methods : Consecutive cataract surgeries from October 2010 to Feb 2011 (1003 eyes, 980 patients; 568 males, 412 females) were analyzed prospectively. Operating surgeon, masked about medication history, noted the intraoperative details. Cases were identified as IFIS or non-IFIS. Multivariate analysis was performed to find risk factors for IFIS. Results : Prevalence of tamsulosin use among men undergoing cataract surgery was 7.0% (41) with incidence of IFIS 4.78% (48). On multivariate analysis, hypertension (OR: 3.2, 95% confidence interval, 95% CI: 1.39-6.57; P = 0.005), use of tamsulosin (OR: 133.32, 95% CI: 50.43-352.48; P < 0.0001), or alfuzosin (OR: 9.36, 95% CI: 2.34-37.50; P = 0.002) were the factors associated with IFIS. Among men taking tamsulosin (n = 41) and alfuzosin (n = 28), 68.3% and 16.6% developed IFIS, respectively. In subgroup analysis of men on tamsulosin, no factor added to the risk posed by tamsulosin. Seventeen of 944 eyes not exposed to any drug had IFIS (0.018%). On subgroup analysis, only risk factor for IFIS was hypertension (OR: 4.67, 95% CI: 1.63-13.35; P = 0.002). Of 48 IFIS eyes, the surgeon observed increased difficulty in 57.1% (21) and additional measures were required in 9 eyes. Mean operative time was increased in IFIS eyes (11.68 ± 3.46 vs. 10.01 ± 0.22 min; P = 0.001). Surgical outcome was good in all cases. Conclusion : The prevalence of tamsulosin intake and IFIS incidence is higher in India. Current tamsulosin/alfuzosin use and hypertension are important risk factors. IFIS makes the surgery more difficult, significantly prolongs the operative time, and predisposes for other intraoperative complications. However, with appropriate management, final operative outcome is not affected.
ISSN:	0301-4738 1998-3689
DOI:	10.4103/0301-4738.141051