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

• Main Authors: Shilpa Goyal, Deepansh Dalela, Neeraj Kumar Goyal, Shobhit Chawla, Rajat Dhesi, Bela Kamboj, Abha Dalela
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2014-01-01
• Series: Indian Journal of Ophthalmology
• Subjects: Acromegaly; central corneal thickness; intraocular pressure; optic disc topography; retinal nerve fiber layer thickness; Best-corrected visual acuity; inner segment/outer segment junction; outer retinal corrugation; rhegmatogenous retinal detachment; Diabetic retinopathy; Indian eyes; nonmydriatic imaging; screening; Capsular; dehiscence; foldable intraocular lens; injector implantation; scleral fixation; Dexamethasone; phacoemulsification; triamcinolone acetonide; Axial length elongation; body stature growth; lifestyle; myopia; Cataract; floppy iris syndrome; tamsulosin
• Online Access: http://www.ijo.in/article.asp?issn=0301-4738;year=2014;volume=62;issue=8;spage=870;epage=875;aulast=Goyal

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.