Femtosecond Laser–Associated Miosis
The use of a femtosecond laser for lens fragmentation and creation of incisions prior to phacoemulsification can result in pupillary miosis by a different mechanism than IFIS. Compared to control cataract surgery patients, aqueous humor concentrations of cytokines and prostaglandin E2 (PGE2) are elevated following femtosecond laser treatment.
Preoperative use of topical nonsteroidal anti-inflammatory drugs (NSAIDs) mitigates the rise in PGE2 levels after femtosecond laser treatment, and reduces, but does not eliminate, the associated miosis. Femtosecond laser–induced pupillary miosis may be managed by the same strategies listed for IFIS (see sidebar above).
Chang DF. Intraoperative floppy iris syndrome. Focal Points: Clinical Modules for Ophthalmologists. American Academy of Ophthalmology; 2010, module 11.
Jun JH, Hwang KY, Chang SD, Joo CK. Pupil-size alterations induced by photodisruption during femtosecond laser-assisted cataract surgery. J Cataract Refract Surg. 2015;41(2):278–285.
Jun JH, Yoo YS, Lim SA, Joo CK. Effects of topical ketorolac tromethamine 0.45% on intraoperative miosis and prostaglandin E2 release during femtosecond laser-assisted cataract surgery. J Cataract Refract Surg. 2017;43(4):492–497.
Excerpted from BCSC 2020-2021 series: Section 11 - Lens and Cataract. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.