Top

Graefe's Archive for Clinical and Experimental Ophthalmology

Published in:

10-07-2023 | Cataract | Cataract

Prospective analysis of anatomic features predisposing patients to intraoperative floppy iris syndrome

Authors: Karin Paschon, Stephan Szegedi, Birgit Weingessel, Klemens Fondi, Wolfgang Huf, Pia Veronika Vécsei-Marlovits

Published in: Graefe's Archive for Clinical and Experimental Ophthalmology | Issue 1/2024

Abstract

Purpose

To aid preoperative risk assessment by identifying anatomic parameters corresponding with a higher risk of intraoperative floppy iris syndrome (IFIS) during cataract surgery.

Methods

Prospective cohort study of 55 patients with α₁-adrenergic receptor antagonist (α₁-ARA) treatment and 55 controls undergoing cataract surgery. Anterior segment optical coherence tomography (AS-OCT), video pupilometer, and biometry measurements were performed preoperatively and analyzed regarding anatomic parameters that corresponded with a higher rate of IFIS. Those statistically significant parameters were evaluated with logistic regression analysis and receiver operating characteristic (ROC) curve.

Results

Pupil diameter was significantly smaller in patients who developed IFIS compared to those who did not develop IFIS (AS-OCT 3.29 ± 0.85 vs. 3.63 ± 0.68, p = 0.03; Pupilometer 3.56 ± 0,87 vs. 3.95 ± 0.67, p = 0.02). Biometric evaluation revealed shallower anterior chambers in the IFIS group (ACD 3.12 ± 0.40 vs. 3.32 ± 0.42, p = 0.02). Cutoff values for 50% IFIS probability (p = 0.5) were PD = 3.18 mm for pupil diameter and ACD = 2.93 mm for anterior chamber depth. ROC curves of combined parameters were calculated for α₁-ARA medication with pupil diameter and anterior chamber depth, which yielded an AUC of 0.75 for all IFIS grades.

Conclusion

The combination of biometric parameters with history of α₁-ARA medication can improve assessment of risk stratification for IFIS incidence during cataract surgery.

Available only for authorised users

Christou CD, Tsinopoulos I, Ziakas N, Tzamalis A (2020) Intraoperative Floppy Iris Syndrome: Updated Perspectives. Clin Ophthalmol 14:463–471. https://doi.org/10.2147/OPTH.S221094CrossRefPubMedPubMedCentral

Chang DF, Braga-Mele R, Mamalis N et al (2008) ASCRS White Paper: clinical review of intraoperative floppy-iris syndrome. J Cataract Refract Surg 34:2153–2162. https://doi.org/10.1016/j.jcrs.2008.08.031CrossRefPubMed

Wahl M, Tipotsch-Maca SM, Vecsei-Marlovits PV (2017) Intraoperative floppy iris syndrome and its association with various concurrent medications, bulbus length, patient age and gender. Graefes Arch Clin Exp Ophthalmol 255:113–118. https://doi.org/10.1007/s00417-016-3515-7CrossRefPubMed

Chang DF, Campbell JR (2005) Intraoperative floppy iris syndrome associated with tamsulosin. J Cataract Refract Surg 31:664–673. https://doi.org/10.1016/j.jcrs.2005.02.027CrossRefPubMed

Enright JM, Karacal H, Tsai LM (2017) Floppy iris syndrome and cataract surgery. Curr Opin Ophthalmol 28:29–34. https://doi.org/10.1097/ICU.0000000000000322CrossRefPubMed

Tzamalis A, Matsou A, Dermenoudi M et al (2019) The role of sex in intraoperative floppy-iris syndrome. J Cataract Refract Surg 45:41–47. https://doi.org/10.1016/j.jcrs.2018.08.029CrossRefPubMed

Ugarte M, Leong T, Rassam S, Kon CH (2007) Intraoperative floppy-iris syndrome, alpha1-adrenergic antagonists, and chronic intake of mianserin: is there an association? J Cataract Refract Surg 33:170. https://doi.org/10.1016/j.jcrs.2006.07.047CrossRefPubMed

Matsuo M, Sano I, Ikeda Y et al (2016) Intraoperative floppy-iris syndrome associated with use of antipsychotic drugs. Can J Ophthalmol 51:294–296. https://doi.org/10.1016/j.jcjo.2016.02.008CrossRefPubMed

Kaczmarek IA, Prost ME, Wasyluk J (2019) Clinical risk factors associated with intraoperative floppy iris syndrome: a prospective study. Int Ophthalmol 39:541–549. https://doi.org/10.1007/s10792-018-0840-3CrossRefPubMed

10.

Goseki T, Ishikawa H, Ogasawara S et al (2012) Effects of tamsulosin and silodosin on isolated albino and pigmented rabbit iris dilators: possible mechanism of intraoperative floppy-iris syndrome. J Cataract Refract Surg 38:1643–1649. https://doi.org/10.1016/j.jcrs.2012.05.025CrossRefPubMed

11.

Panagis L, Basile M, Friedman AH, Danias J (2010) Intraoperative floppy iris syndrome: report of a case and histopathologic analysis. Arch Ophthalmol 128:1437–1441. https://doi.org/10.1001/archophthalmol.2010.243CrossRefPubMed

12.

Schwinn DA, Michelotti GA (2000) alpha1-adrenergic receptors in the lower urinary tract and vascular bed: potential role for the alpha1d subtype in filling symptoms and effects of ageing on vascular expression. BJU Int 85(Suppl 2):6–11. https://doi.org/10.1046/j.1464-410x.2000.00061.xCrossRefPubMed

13.

Dogan M, Kutluksaman B, Keles I et al (2017) The Effects of Systemic Alfuzosin and Tamsulosin Hydrochloride on Choroidal Thickness and Pupil Diameter Sizes in Cases with Benign Prostatic Hyperplasia. Curr Eye Res 42:1638–1643. https://doi.org/10.1080/02713683.2017.1359306CrossRefPubMed

14.

Wierzchowski T, Wilczynski M, Palenga-Pydyn D et al (2016) Intraoperative floppy iris syndrome – epidemiology and clinical assessment. Klin Oczna 118:187–190PubMed

15.

Lim DH, Lee MG, Chung T-Y, Chung E-S (2014) Korean patients taking α1-adrenergic receptor antagonists show lower incidence of intraoperative floppy iris syndrome than western patients. Br J Ophthalmol 98:479–483. https://doi.org/10.1136/bjophthalmol-2013-304135CrossRefPubMed

16.

Prata TS, Palmiero P-M, Angelilli A et al (2009) Iris Morphologic Changes Related to α1-Adrenergic Receptor Antagonists: Implications for Intraoperative Floppy Iris Syndrome. Ophthalmology 116:877–881. https://doi.org/10.1016/j.ophtha.2008.12.040CrossRefPubMed

17.

Kordasz ML, Manicam C, Steege A et al (2014) Role of α1-adrenoceptor subtypes in pupil dilation studied with gene-targeted mice. Invest Ophthalmol Vis Sci 55:8295–8301. https://doi.org/10.1167/iovs.14-15706CrossRefPubMed

18.

Casuccio A, Cillino G, Pavone C et al (2011) Pharmacologic pupil dilation as a predictive test for the risk for intraoperative floppy-iris syndrome. J Cataract Refract Surg 37:1447–1454. https://doi.org/10.1016/j.jcrs.2011.02.030CrossRefPubMed

19.

Zaman F, Bach C, Junaid I et al (2012) The floppy iris syndrome - what urologists and ophthalmologists need to know. Curr Urol 6:1–7. https://doi.org/10.1159/000338861CrossRefPubMedPubMedCentral

20.

Lunacek A, Mohamad Al-Ali B, Radmayr C et al (2018) Ten years of intraoperative floppy iris syndrome in the era of α-blockers. Cent European J Urol 71:98–104. https://doi.org/10.5173/ceju.2017.1234CrossRefPubMed

21.

Docherty JR (2019) The pharmacology of α1-adrenoceptor subtypes. Eur J Pharmacol 855:305–320. https://doi.org/10.1016/j.ejphar.2019.04.047CrossRefPubMed

22.

Chiseliţă D, Cantemir A, Epifanov L et al (2012) Management of intraoperative floppy iris syndrome. Oftalmologia 56:69–76PubMed

23.

Esen F, Bulut AE, Toker E (2018) Efficacy and safety of low-concentration, bisulphite-containing, intracameral epinephrine and topical atropine treatments for the prevention of intraoperative floppy iris syndrome. Cutan Ocul Toxicol 37:286–290. https://doi.org/10.1080/15569527.2018.1456448CrossRefPubMed

24.

Manvikar S, Allen D (2006) Cataract surgery management in patients taking tamsulosin staged approach. J Cataract Refract Surg 32:1611–1614. https://doi.org/10.1016/j.jcrs.2006.04.037CrossRefPubMed

25.

Silverstein SM, Rana VK, Stephens R et al (2018) Effect of phenylephrine 1.0%-ketorolac 0.3% injection on tamsulosin-associated intraoperative floppy-iris syndrome. J Cataract Refract Surg 44:1103–1108. https://doi.org/10.1016/j.jcrs.2018.05.029CrossRefPubMed

26.

Cicchetti DV (1994) Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychol Assess 6:284CrossRef

27.

Datta D (2017) blandr: a Bland-Altman Method Comparison package for R. https://doi.org/10.5281/zenodo.824514. https://github.com/deepankardatta/blandr

28.

Mandrekar JN (2010) Receiver Operating Characteristic Curve in Diagnostic Test Assessment. J Thorac Oncol 5:1315–1316. https://doi.org/10.1097/JTO.0b013e3181ec173dCrossRefPubMed

29.

Polo TCF, Miot HA (2020) Use of ROC curves in clinical and experimental studies. J Vasc Bras 19:e20200186. https://doi.org/10.1590/1677-5449.200186CrossRefPubMedPubMedCentral

30.

Safir M, Hecht I, Hartstein ME et al (2021) Preoperative ocular characteristics predicting the development of intraoperative floppy iris syndrome regardless of alpha-antagonist exposure status. Graefes Arch Clin Exp Ophthalmol 259:1209–1214. https://doi.org/10.1007/s00417-020-05060-5CrossRefPubMed

31.

Chen AA, Kelly JP, Bhandari A, Wu MC (2010) Pharmacologic prophylaxis and risk factors for intraoperative floppy-iris syndrome in phacoemulsification performed by resident physicians. J Cataract Refract Surg 36:898–905. https://doi.org/10.1016/j.jcrs.2009.12.039CrossRefPubMed

32.

Terauchi Y, Horiguchi H, Shiba T (2018) The Pharmacological Mydriatic Pupil-to-Limbal Diameter Ratio as an Intuitive Predictor for the Risk of Intraoperative Floppy Iris Syndrome. J Ophthalmol 2018:2837934. https://doi.org/10.1155/2018/2837934CrossRefPubMedPubMedCentral

33.

Saitoh K, Yoshida K, Hamatsu Y, Tazawa Y (2004) Changes in the shape of the anterior and posterior corneal surfaces caused by mydriasis and miosis: detailed analysis. J Cataract Refract Surg 30:1024–1030. https://doi.org/10.1016/j.jcrs.2003.10.040CrossRefPubMed

Title: Prospective analysis of anatomic features predisposing patients to intraoperative floppy iris syndrome
Authors: Karin Paschon
Stephan Szegedi
Birgit Weingessel
Klemens Fondi
Wolfgang Huf
Pia Veronika Vécsei-Marlovits
Publication date: 10-07-2023
Publisher: Springer Berlin Heidelberg
Keywords: Cataract
Carvedilol
Tamsulosin
Finasteride
Published in: Graefe's Archive for Clinical and Experimental Ophthalmology / Issue 1/2024
Print ISSN: 0721-832X
Electronic ISSN: 1435-702X
DOI: https://doi.org/10.1007/s00417-023-06165-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Prospective analysis of anatomic features predisposing patients to intraoperative floppy iris syndrome

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2024

Predicting the postoperative intraocular lens position based on IOL Master 700 biometry, compared with results from the anterior segment analysis system

Ocular manifestations of obstructive sleep apnea: a systematic review and meta-analysis

Historical value and the future of Graefes

Comparison of corneal tomographic parameters between Hispanic and non-Hispanic patients

Peripapillary hyperreflective ovoid mass-like structures (PHOMS) in patients with acute Leber’s hereditary optic neuropathy

Posture-related fluctuations of intraocular pressure in healthy children with suspicion of glaucoma