Top

International Ophthalmology

Published in:

Open Access 01-03-2019 | Original Paper

Clinical risk factors associated with intraoperative floppy iris syndrome: a prospective study

Authors: Ilona A. Kaczmarek, Marek E. Prost, Jaromir Wasyluk

Published in: International Ophthalmology | Issue 3/2019

Abstract

Purpose

To evaluate the incidence of and factors associated with intraoperative floppy iris syndrome (IFIS) in patients undergoing cataract phacoemulsification.

Methods

In total, 319 eyes of 319 patients who underwent phacoemulsification with implantation of an intraocular lens (IOL) into the posterior chamber were included in this study. Direct injection of epinephrine into the anterior chamber was performed in all cases. The following patient information was collected: gender, age, axial length of the eye, presence of pseudoexfoliation syndrome, glaucoma, diabetes mellitus, hypertension, current use of medications including alpha1 adrenergic receptor antagonists (alpha1-ARAs), finasteride, and benzodiazepines, duration of intake of alpha1-ARAs and finasteride, and duration of the surgery. Patients were classified as IFIS or non-IFIS after the surgery. Univariate and multivariate logistic regression analyses were performed.

Results

The overall incidence of IFIS was 9.09% (29/319 eyes). The multivariate analysis revealed that tamsulosin use (P = 0.004), finasteride use (P = 0.014), and increasing age (P = 0.006) were significantly associated with IFIS. Male gender and benzodiazepine use were significantly associated with IFIS in the univariate analysis, but not in the multivariate analysis. The non-selective alpha1-ARA doxazosin was not found to be associated with IFIS.

Conclusions

The findings suggest that finasteride use and aging are risk factors for IFIS and confirm the association of tamsulosin use with IFIS. Further, doxazosin appears to be a relatively safe drug with respect to the occurrence of IFIS.

Chang DF, Campbell JR (2005) Intraoperative floppy iris syndrome associated with tamsulosin. J Cataract Refract Surg 31(4):664–673. https://doi.org/10.1016/j.jcrs.2005.02.027 CrossRefPubMed

Goyal S, Dalela D, Goyal NK et al (2014) Intraoperative floppy iris syndrome in Indian population: a prospective study on incidence, risk factors, and impact on operative performance. Indian J Ophthalmol 62(8):870–875. https://doi.org/10.4103/0301-4738.141051 CrossRefPubMedPubMedCentral

Chatziralli IP, Sergentanis TN, Papazisis L, Moschos MM (2012) Risk factors for intraoperative floppy iris syndrome: a retrospective study. Acta Ophthalmol 90(2):e152–e153. https://doi.org/10.1111/j.1755-3768.2011.02132.x CrossRefPubMed

Chatziralli IP, Peponis V, Parikakis E, Maniatea A, Patsea E, Mitropoulos P (2016) Risk factors for intraoperative floppy iris syndrome: a prospective study. Eye 30(8):152–153. https://doi.org/10.1038/eye.2016.122 CrossRef

Matsuo M, Sano I, Ikeda Y, Fujihara E, Tanito M (2016) Intraoperative floppy-iris syndrome associated with use of antipsychotic drugs. Can J Ophthalmol 51(4):294–296. https://doi.org/10.1016/j.jcjo.2016.02.008 CrossRefPubMed

Issa SA, Dagres E (2007) Intraoperative floppy-iris syndrome and finasteride intake. J Cataract Refract Surg 33(12):2142–2143. https://doi.org/10.1016/j.jcrs.2007.07.025 CrossRefPubMed

Gravas S, Bach T, Bachmann A et al (2016) EAU guidelines on management of non neurogenic male LUTS. Eur Assoc Urol Guidel 21–23

Wahl M, Tipotsch-Maca SM, Vecsei-Marlovits PV (2016) Intraoperative floppy iris syndrome and its association with various concurrent medications, bulbus length, patient age and gender. Graefe’s Arch Clin Exp Ophthalmol. https://doi.org/10.1007/s00417-016-3515-7 CrossRef

Vollman DE, Gonzalez-Gonzalez LA, Chomsky A, Daly MK, Baze E, Lawrence MG (2014) Intra-operative floppy iris and prevalence of intra-operative complications: results from Ophthalmic Surgery Outcomes Database. Am J Ophthalmol 158(4):847–848. https://doi.org/10.1016/j.ajo.2014.06.027 CrossRefPubMed

10.

Neff KD, Sandoval HP, Fernández de Castro LE, Nowacki AS, Vroman DT, Solomon KD (2009) Factors associated with intraoperative floppy iris syndrome. Ophthalmology 116(4):658–663. https://doi.org/10.1016/j.ophtha.2008.12.026 CrossRefPubMed

11.

Altan-Yaycioglu R, Gedik S, Pelit A, Akova YA, Akman A (2009) Clinical factors associated with floppy iris signs: a prospective study from two centers. Ophthalmic Surg Lasers Imaging 40(3):232–238. https://doi.org/10.9999/15428877-20090430-02 CrossRefPubMed

12.

Altiaylik Ozer P, Altiparmak UE, Unlu N, Hazirolan DO, Kasim R, Duman S (2013) Intraoperative floppy-iris syndrome: comparison of tamsulosin and drugs other than alpha antagonists. Curr Eye Res 38(4):480–486. https://doi.org/10.3109/02713683.2013.763986 CrossRefPubMed

13.

Lim DH, Lee MG, Chung T-Y, Chung E-S (2014) Korean patients taking alpha1-adrenergic receptor antagonists show lower incidence of intraoperative floppy iris syndrome than western patients. Br J Ophthalmol 98(4):479–483. https://doi.org/10.1136/bjophthalmol-2013-304135 CrossRefPubMed

14.

Shah N, Tendulkar M, Brown R (2009) Should we anticipate intraoperative floppy iris syndrome (IFIS) even with very short history of tamsulosin? Eye 23(3):740. https://doi.org/10.1038/Eye.2008.95 CrossRefPubMed

15.

Hieble JP, Bylund DB, Clarke DE et al (1990) International Union of Pharmocology X. Recommendation for nomenclature of a1-adrenoceptors: consensus update. Pharmacol Rev 47(2):297–314

16.

Yu Y, Koss MC (2003) Studies of alpha-adrenoceptor antagonists on sympathetic mydriasis in rabbits. J Ocul Pharmacol Ther 19(3):255–263. https://doi.org/10.1089/108076803321908374 CrossRefPubMed

17.

Yu Y, Koss MC (2003) Functional characterization of alpha-adrenoceptors mediating pupillary dilation in rats. Eur J Pharmacol 471(2):135–140CrossRefPubMed

18.

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 syn- drome. J Cataract Refract Surg 38:1643–1649. https://doi.org/10.1016/j.jcrs.2012.05.025 CrossRefPubMed

19.

Shtein RM, Hussain MT, Cooney TM, Elner VM, Hood CT (2014) Effect of tamsulosin on iris vasculature and morphology. J Cataract Refract Surg 40(5):793–798. https://doi.org/10.1016/j.jcrs.2013.10.031 CrossRefPubMedPubMedCentral

20.

Chang DF, Campbell JR, Colin J, Schweitzer C (2014) Prospective masked comparison of intraoperative floppy iris syndrome severity with tamsulosin versus alfuzosin. Ophthalmology 121(4):829–834. https://doi.org/10.1016/j.ophtha.2013.10.031 CrossRefPubMed

21.

Blouin M, Blouin J, Perreault S, Lapointe A, Dragomir A (2007) Intraoperative floppy-iris syndrome associated with alpha1-adrenoreceptors: comparison of tamsulosin and alfuzosin. J Cataract Refract Surg 33(7):1227–1234. https://doi.org/10.1016/j.jcrs.2007.03.032 CrossRefPubMed

22.

Intraoperative Floppy Iris Syndrome (IFIS) Associated with Systemic Alpha-1 Antagonists (2014) ASCRS and AAO Educational Update Statement, ASCRS and AAO Quality of Care Secretariat, Hoskins Center for Quality Eye Care

23.

Chatziralli IP, Sergentanis TN (2011) Risk factors for intraoperative floppy Iris syndrome: a meta-analysis. Ophthalmology 118(4):730–735. https://doi.org/10.1016/j.ophtha.2010.08.039 CrossRefPubMed

24.

Schwinn DA, Afshari NA (2006) α1-adrenergic receptor antagonists and the iris: new mechanistic insights into floppy iris syndrome. Surv Ophthalmol 51(5):501–512. https://doi.org/10.1016/j.survophthal.2006.06.011 CrossRefPubMed

25.

Wong ACM, Mak ST (2011) Finasteride-associated cataract and intraoperative floppy-iris syndrome. J Cataract Refract Surg 37(7):1351–1354. https://doi.org/10.1016/j.jcrs.2011.04.013 CrossRefPubMed

26.

Horvath K, Vultur F, Simon V, Voidazan S, Gh M (2015) Research on intraoperative iris behavior in rabbits treated with tamsulosin and finasteride. Hippokratia 19(1):20–24PubMedPubMedCentral

27.

Takayanagi I (1994) Effects of aging on drug receptor mechanisms in smooth muscles. Nihon Yakurigaku Zasshi. Folia Pharmacol Jpn 104(3):163–175CrossRef

28.

Panagis L, Basile M, Friedman AH, Danias J (2010) Intraoperative floppy iris syndrome: report of a case and histopathologic analysis. Arch Ophthalmol 128(11):1437–1441CrossRefPubMed

29.

Satoh K, Takaku Y, Ohtsuki K, Mizuno K (1999) Effects of aging on fluorescein leakage in the iris and angle in normal subjects. Jpn J Ophthalmol 43(3):166–170CrossRefPubMed

30.

Chang DF, Braga-Mele R, Mamalis N et al (2008) Clinical experience with intraoperative floppy-iris syndrome. Results of the 2008 ASCRS member survey. J Cataract Refract Surg 34(7):1201–1209. https://doi.org/10.1016/j.jcrs.2008.04.014 CrossRefPubMed

31.

Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR (1996) A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol 49(12):1373–1379CrossRefPubMed

Title: Clinical risk factors associated with intraoperative floppy iris syndrome: a prospective study
Authors: Ilona A. Kaczmarek
Marek E. Prost
Jaromir Wasyluk
Publication date: 01-03-2019
Publisher: Springer Netherlands
Published in: International Ophthalmology / Issue 3/2019
Print ISSN: 0165-5701
Electronic ISSN: 1573-2630
DOI: https://doi.org/10.1007/s10792-018-0840-3

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Clinical risk factors associated with intraoperative floppy iris syndrome: a prospective study

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2019

Results of ethanol-assisted epithelium-on corneal cross-linking with and without intrastromal corneal ring implantation

Validation of the structure–function correlation report from the heidelberg edge perimeter and spectral-domain optical coherence tomography

Deep blue dot corneal degeneration: confocal characteristics

Tear Martix Metalloproteinase-9 and Tissue Inhibitor of Metalloproteinase-1 in Post-Lasik Ectasia

Multi-viral canaliculitis: case report and review of literature

Acknowledgement to our reviewers 2018