Skip to main content
SpringerLink
Log in

Modified corneal incisions in intraoperative floppy iris syndrome (IFIS)-prone patients

  • Cataract
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Background

We aimed to report a simple technique that involves modified anterior (to the limbus) elongated corneal incisions in order to reduce the incidence and severity of intraoperative floppy iris syndrome (IFIS) and related complications.

Methods

This was a retrospective study of phacoemulsification cataract surgeries performed by a single surgeon on patients receiving tamsulosin or alfuzosin between 1 January 2009 and 31 July 2012 at Meir Medical Center, Kfar-Sava, Israel. We recorded preoperative gender, age, α-antagonist medication, coexisting pseudoexfoliation (PXF), and intraoperative use of ophthalmic viscosurgical devices (OVDs), pupil size, complications, IFIS grading and the need for additional operative strategies to manage IFIS. Elongated corneal incisions were performed approximately 1 mm anterior to the limbus.

Results

Ninety-three eyes of 81 men were included. Mean age was 76.5 years (range 55 to 96 years). Forty-seven eyes (40 patients) had documented use of alfuzosin and 45 eyes (40 patients) of tamsulosin. One patient received both. The overall rate of IFIS was 22.6 % (n = 21). Eyes of patients who were treated with alfuzosin had a milder grading (p < 0.001) and an overall lower percentage of IFIS compared to tamsulosin (4.26 % versus 42.22 % respectively, p < 0.001). No additional strategies were used to manage IFIS during surgery. No intraoperative complications occurred.

Conclusion

Anterior elongated incisions are simple and efficient in preventing IFIS, exempting the surgeon from the use of additional expensive devices or materials in most cases. They do not limit the surgeon to one strategy, and therefore, if necessary, another may be applied at any given time.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Chang DF, Campbell JR (2005) Intraoperative floppy iris syndrome associated with tamsulosin. J Cataract Refract Surg 31:664–673

    Article  PubMed  Google Scholar 

  2. Blouin MC, 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 33:1227–1234

    Article  PubMed  Google Scholar 

  3. Takmaz T, Can I (2007) Intraoperative floppy-iris syndrome: do we know everything about it? J Cataract Refract Surg 33:1110–1112

    Article  PubMed  Google Scholar 

  4. Handzel DM, Briesen S, Rausch S, Kalble T (2012) Cataract surgery in patients taking alpha-1 antagonists: know the risks, avoid the complications. Dtsch Arztebl Int 109:379–384

    PubMed  PubMed Central  Google Scholar 

  5. Takmaz T, Can I (2007) Clinical features, complications, and incidence of intraoperative floppy iris syndrome in patients taking tamsulosin. Eur J Ophthalmol 17:909–913

    PubMed  CAS  Google Scholar 

  6. Chang DF, Braga-Mele R, Mamalis N, Masket S, Miller KM, Nichamin LD, Packard RB, Packer M and Committee ACC (2008) Clinical experience with intraoperative floppy-iris syndrome. Results of the (2008) ASCRS member survey. J Cataract Refract Surg 34:1201–1209

    Article  Google Scholar 

  7. Lim LA, Frost A (2006) Iris tears secondary to intraoperative floppy-iris syndrome associated with tamsulosin. J Cataract Refract Surg 32:1777

    Article  PubMed  Google Scholar 

  8. Bendel RE, Phillips MB (2006) Preoperative use of atropine to prevent intraoperative floppy-iris syndrome in patients taking tamsulosin. J Cataract Refract Surg 32:1603–1605

    Article  PubMed  Google Scholar 

  9. Masket S, Belani S (2007) Combined preoperative topical atropine sulfate 1% and intracameral nonpreserved epinephrine hydrochloride 1:4000 [corrected] for management of intraoperative floppy-iris syndrome. J Cataract Refract Surg 33:580–582

    Article  PubMed  Google Scholar 

  10. Gurbaxani A, Packard R (2007) Intracameral phenylephrine to prevent floppy iris syndrome during cataract surgery in patients on tamsulosin. Eye (Lond) 21:331–332

    Article  CAS  Google Scholar 

  11. Oetting TA, Omphroy LC (2002) Modified technique using flexible iris retractors in clear corneal cataract surgery. J Cataract Refract Surg 28:596–598

    Article  PubMed  Google Scholar 

  12. Graether JM (1996) Graether pupil expander for managing the small pupil during surgery. J Cataract Refract Surg 22:530–535

    Article  PubMed  CAS  Google Scholar 

  13. Chang DF (2008) Use of Malyugin pupil expansion device for intraoperative floppy-iris syndrome: results in 30 consecutive cases. J Cataract Refract Surg 34:835–841

    Article  PubMed  Google Scholar 

  14. Kershner RM (2002) Management of the small pupil for clear corneal cataract surgery. J Cataract Refract Surg 28:1826–1831

    Article  PubMed  Google Scholar 

  15. Tint NL, Dhillon AS, Alexander P (2012) Management of intraoperative iris prolapse: stepwise practical approach. J Cataract Refract Surg 38:1845–1852

    Article  PubMed  Google Scholar 

  16. Chatziralli IP, Sergentanis TN (2011) Risk factors for intraoperative floppy iris syndrome: a meta-analysis. Ophthalmology 118:730–735

    Article  PubMed  Google Scholar 

  17. Srinivasan S, Radomski S, Chung J, Plazker T, Singer S, Slomovic AR (2007) Intraoperative floppy-iris syndrome during cataract surgery in men using alpha-blockers for benign prostatic hypertrophy. J Cataract Refract Surg 33:1826–1827

    Article  PubMed  Google Scholar 

  18. Cheung CM, Awan MA, Sandramouli S (2006) Prevalence and clinical findings of tamsulosin-associated intraoperative floppy-iris syndrome. J Cataract Refract Surg 32:1336–1339

    Article  PubMed  Google Scholar 

  19. Chang DF, Osher RH, Wang L, Koch DD (2007) Prospective multicenter evaluation of cataract surgery in patients taking tamsulosin (Flomax). Ophthalmology 114:957–964

    Article  PubMed  Google Scholar 

  20. Al-Bdour MD, Al-Till MI, Idrees GM, Abu Samra KM (2008) Pseudoexfoliation syndrome at Jordan University Hospital. Acta Ophthalmol 86:755–757

    Article  PubMed  Google Scholar 

  21. 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 40:232–238

    Article  PubMed  Google Scholar 

  22. Hayashi K, Yoshida M, Hayashi H (2010) Corneal shape changes after 2.0-mm or 3.0-mm clear corneal versus scleral tunnel incision cataract surgery. Ophthalmology 117:1313–1323

    Article  PubMed  Google Scholar 

  23. Masket S, Wang L, Belani S (2009) Induced astigmatism with 2.2- and 3.0-mm coaxial phacoemulsification incisions. J Refract Surg 25:21–24

    PubMed  Google Scholar 

  24. Endophthalmitis Study Group ESoC and Refractive S (2007) Prophylaxis of postoperative endophthalmitis following cataract surgery: results of the ESCRS multicenter study and identification of risk factors. J Cataract Refract Surg 33:978–988

    Article  Google Scholar 

Download references

Author information

Author notes

    Authors and Affiliations

    1. Department of Ophthalmology, Meir Medical Center, 59 Tchernichovsky St., Kfar Sava, 44410, Israel

      Sharon Armarnik, Eli Rosen, Ehud I. Assia & Fani Segev

    2. Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel

      Michael Mimouni

    Authors
    1. Sharon Armarnik
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Michael Mimouni
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Eli Rosen
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Ehud I. Assia
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Fani Segev
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Fani Segev.

    Ethics declarations

    Conflict of Interest

    All authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

    Funding

    No funding was received for this research.

    Ethical Approval

    All data for this retrospective cohort study were collected and analyzed in accordance with the policies and procedures of the Institutional Review Board of the Meir Medical Center and the tenets set forth in the declaration of Helsinki.

    Informed Consent

    In view of the retrospective consecutive design of this study, the need for written informed consent was waived by the Institutional Review Board Committee.

    Additional information

    Sharon Armarnik and Michael Mimouni contributed equally to this work.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Armarnik, S., Mimouni, M., Rosen, E. et al. Modified corneal incisions in intraoperative floppy iris syndrome (IFIS)-prone patients. Graefes Arch Clin Exp Ophthalmol 254, 123–127 (2016). https://doi.org/10.1007/s00417-015-3188-7

    Download citation

    • Received:

    • Revised:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s00417-015-3188-7

    Keywords

    Search

    Navigation