Intraoperative floppy iris syndrome

Intraoperative Floppy Iris Syndrome (IFIS) is a complication that can occur during cataract surgery. It is characterized by a flaccid iris that billows in response to intraoperative fluid currents, a propensity for the iris to prolapse towards the surgical incisions, and progressive intraoperative pupil constriction. IFIS was first described in 2005 by Chang and Campbell.

Causes

IFIS is most commonly associated with the use of systemic alpha-1 adrenergic receptor antagonists, particularly tamsulosin, a medication used to treat benign prostatic hyperplasia. Other medications, such as antidepressants, antipsychotics, and benzodiazepines, have also been associated with IFIS.

Symptoms

The primary symptoms of IFIS are a flaccid iris that billows in response to intraoperative fluid currents, a propensity for the iris to prolapse towards the surgical incisions, and progressive intraoperative pupil constriction.

Diagnosis

IFIS is typically diagnosed during cataract surgery when the characteristic symptoms are observed. Preoperative recognition of risk factors, such as the use of certain medications, can help anticipate the occurrence of IFIS.

Treatment

The management of IFIS involves the use of various surgical techniques and devices to prevent iris prolapse and maintain pupil dilation during cataract surgery. These may include the use of iris hooks or pupil expansion rings, and the modification of surgical techniques.

Prevention

Prevention strategies for IFIS include preoperative recognition of risk factors and appropriate surgical planning. Patients taking alpha-1 adrenergic receptor antagonists should be informed of the potential risk of IFIS and the possible need for additional surgical measures during cataract surgery.

See also

• Cataract surgery
• Benign prostatic hyperplasia
• Tamsulosin

References

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