Skip to main content
SpringerLink
Log in

Intraoperative floppy iris syndrome and its association with various concurrent medications, bulbus length, patient age and gender

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

Abstract

Purpose

To evaluate the association between intraoperative floppy iris syndrome (IFIS) and concurrent medications containing selective alpha1A receptor antagonists as well as nonselective alpha1-adrenergic receptor antagonists, bulbus length, patient age and gender.

Methods

We performed a prospective data acquisition of IFIS occurrence and grading, and retrospective evaluation of concurrent medications, bulbus length, patient age and gender of all patients undergoing cataract surgery over a 6-month period.

Results

IFIS was observed in 119 of 947 cases (12.6 %). 31 of those 119 patients (26.1 %) had a concurrent medication with a drug that is associated with a higher risk of causing IFIS. Tamsulosin was the drug most commonly associated with IFIS (n = 11), followed by a combination of drugs (n = 7), doxazosin (n = 4), quetiapine (n = 4), finasterid (n = 2), prothipendyl (n = 2), and mianserin (n = 1). Bulbus length and age did not show any significant association with occurrence or grade of IFIS. Gender distribution among IFIS cases was 57.1 % males (n = 68) and 42.9 % (n = 51) females.

Conclusions

The occurrence of IFIS has to be expected with a variety of concurrent medications. The number of IFIS cases and the percentage of females in this series are higher compared to previous reports. The observations might be due to a rising awareness of surgeons or to an increasing number of causative medications on the market.

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.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Chang DF, Campbell JR (2005) Intraoperative floppy iris syndrome associated with tamsolusin. J Cataract Refract Surg 31:664–667

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  3. 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

    Article  PubMed  Google Scholar 

  4. Haridas A, Syrimi M, Al-Ahmar B, Hingorani M (2013) Intraoperative floppy iris syndrome (IFIS) in patients receiving tamsulosin or doxazosin-a UK-based comparison of incidence and complication rates. Graefes Arch Clin Exp Ophthalmol 251:1541–1545

    Article  CAS  PubMed  Google Scholar 

  5. Chang DF, Campbell JR, Colin J, Schweitzer C, Study Surgeon Group (2014) Prospective masked comparison of intraoperative floppy iris syndrome severity with tamsulosin versus alfuzosin. Ophthalmology 121:829–834

    Article  PubMed  Google Scholar 

  6. Chang DF, Braga-Mele R, Mamalis N et al (2008) ASCRS Cataract Clinical Committee. Clinical experience with intraoperative floppy-iris syndrome. Results of the 2008 ASCRS member survey. J Cataract Refract Surg 34:1201–1209

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  8. 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 

  9. Gurbaxani A, Packard R (2007) Intracameral phenylephrine to prevent floppy iris syndrome during cataract surgery in patients on tamsulosin. Eye (Lond) 21:331–2

    Article  CAS  Google Scholar 

  10. Armarnik S, Mimouni M, Rosen E, Assia EI, Segev F (2016) Modified corneal incisions in intraoperative floppy iris syndrome (IFIS)-prone patients. Graefes Arch Clin Exp Ophthalmol 254:123–7

    Article  PubMed  Google Scholar 

  11. Nguyen DQ, Sebastian RT, Kyle G (2007) Surgeon’s experiences of the intraoperative floppy iris syndrome in the United Kingdom. Eye 21:443–444

    Article  CAS  PubMed  Google Scholar 

  12. Cantrell MA, Bream-Rouwenhorst HR, Steffensmeier A, Hemerson P, Rogers M, Stamper B (2008) Intraoperative floppy iris syndrome associated with alpha 1-adrenergic receptor antagonists. Ann Pharmacother 42:558–563

    Article  CAS  PubMed  Google Scholar 

  13. Parssinen O, Leppanen E, Keski-Rahkonen P, Mauriala T, Dugue B, Lehtonen M (2006) Influence of tamsulosin on the iris and its implications for cataract surgery. Invest Ophthalmol Vis Sci 47:3766–3771

    Article  PubMed  Google Scholar 

  14. 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 

  15. Chadha V, Borooah S, Tey A, Styles C, Singh J (2007) Floppy iris behaviour during cataract surgery: associations and variations. Br J Ophthalmol 91:40–42

    Article  CAS  PubMed  Google Scholar 

  16. Cheung CM, Awan MA, Peh KK, Sandramouli S (2007) Incidence of intraoperative floppy iris syndrome in patients on either systemic or topical alpha(1)-adrenoceptor antagonist. Am J Ophthalmol 143:150–151

    Article  Google Scholar 

  17. Blouin MC, Blouin J, Perreault S, Lapointe A, Dragomir A (2007) Intraoperative floppy-iris syndrome associated with alpha-1 adrenoreceptors: comparison of tamsulosin and alfuzosin. J Cataract Refract Surg 33:1227–1234

    Article  PubMed  Google Scholar 

  18. Bell CM, Hatch WV, Fischer HD, Cernat G, Paterson JM, Gruneir A et al (2009) Association between tamsulosin and serious ophthalmic adverse events in older men following cataract surgery. JAMA 301:1991–1996

    Article  CAS  PubMed  Google Scholar 

  19. Casuccio A, Cillino G, Pavone C, Spitale E, Cillino S (2011) Pharmacologic pupil dilation as a predictive test for the risk of intraoperative floppy-iris syndrome. J Cataract Refract Surg 37:1447–1454

    Article  PubMed  Google Scholar 

  20. Shah N, Tendulkar M, Brown R (2009) Should we anticipate intraoperative floppy iris syndrome (IFIS) even with very short history of tamsulosin? Eye (Lond) 23:740

    Article  CAS  Google Scholar 

  21. Herd MK (2007) Intraoperative floppy-iris syndrome with doxazosin. J Cataract Refract Surg 33:562

  22. Dhingra N, Rajkumar KN, Kumar V (2007) Intraoperative floppy iris syndrome with doxazosin. Eye (Lond) 21:678–679

    Article  CAS  Google Scholar 

  23. Settas G, Fitt AW (2006) Intraoperative floppy iris syndrome in a patient taking alfuzosin for benign prostatic hypertrophy. Eye (Lond) 20:1431–1432

    Article  CAS  Google Scholar 

  24. Issa SA, Dagres E (2007) Intraoperative floppy-iris syndrome and finasteride intake. J Cataract Refract Surg 33:2142–2143

    Article  PubMed  Google Scholar 

  25. 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

    Article  PubMed  Google Scholar 

  26. Pringle E, Packard R (2005) Antipsychotic agent as an etiologic agent of IFIS. J Cataract Refract Surg 31:2240–2241

    Article  PubMed  Google Scholar 

  27. Unal M, Yücel I, Tenlik A (2007) Intraoperative floppy-iris syndrome associated with chronic use of chlorpromazine. Eye (Lond) 21:1241–1242

    Article  CAS  Google Scholar 

  28. Austrian Statistics Institute (2000) http://www.statistik.at/web_de/statistiken/menschen_und_gesellschaft/bevoelkerung/bevoelkerungsstruktur/bevoelkerung_nach_alter_geschlecht/index.html. Accessed on July 18 2015

  29. Neff KD, Sandoval HP, Fernández de Castro LE, Nowacki AS, Vroman DT, Solomon KD (2009) Factors associated with intraoperative floppy iris syndrome. Ophthalmology 116:658–663

    Article  PubMed  Google Scholar 

  30. Bilgin B, Ilhan D, Çetinkaya A, Ünal M (2013) Intraoperative floppy iris syndrome associated with quetiapine. Eye (Lond) 27:673

    Article  CAS  Google Scholar 

  31. Wong AC, Mak ST (2011) Finasteride-associated cataract and intraoperative floppy-iris syndrome. J Cataract Refract Surg 37:1351–1354

    Article  PubMed  Google Scholar 

  32. Chatziralli IP, Peponis V, Parikakis E, Maniatea A, Patsea E, Mitropoulos P (2016) Risk factors for intraoperative floppy iris syndrome: a prospective study. Eye (Lond) 30:1039–44

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Ophthalmology, Hietzing Hospital, Wolkersbergenstrasse 1, 1130, Vienna, Austria

    Michael Wahl, Saskia M. Tipotsch-Maca & Pia V. Vecsei-Marlovits

  2. Karl Landsteiner Institute for Process Optimization and Quality Management in Cataract Surgery, Hietzing Hospital, Wolkersbergenstrasse 1, 1130, Vienna, Austria

    Michael Wahl, Saskia M. Tipotsch-Maca & Pia V. Vecsei-Marlovits

Authors
  1. Michael Wahl
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Saskia M. Tipotsch-Maca
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pia V. Vecsei-Marlovits
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pia V. Vecsei-Marlovits.

Ethics declarations

Funding

No funding was received for this research.

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.

Ethical approval

All procedures in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study, formal consent is not required.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wahl, M., Tipotsch-Maca, S.M. & Vecsei-Marlovits, P.V. 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 (2017). https://doi.org/10.1007/s00417-016-3515-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-016-3515-7

Keywords

Search

Navigation