• Cataract/Anterior Segment, Comprehensive Ophthalmology

    This study compared the incidence of intraoperative floppy-iris syndrome (IFIS) in male and female patients undergoing cataract surgery.

    Study design

    This comparative retrospective case-control study comprised 1,678 female and 1,535 male patients (1,937 and 1,874 eyes, respectively) from a single center. All patients received the same standardized preoperative dilation and underwent phacoemulsification with the same device. IFIS was assessed using a standardized grading system.


    The overall incidence of IFIS was 3.2%; the incidence was lower among females than males (1.3% vs. 5.2%; P<0.0001). Approximately 72% of males reported intake of alpha 1 receptor blockers compared with 0% of females. However, females with IFIS were at a higher risk for posterior capsule tear (OR 6.6), vitreous loss (OR 8.1) and nucleus drop (OR 12.3). Researchers noted that posterior capsule rupture and final CDVA were the only factors that correlated with IFIS severity grade in females.


    Although the study did not report any female patients on alpha 1 receptor blockers, many females are often unaware that they were given this medication for urinary tract problems. Since nurses recording patient histories are often unaware of this potential IFIS complication, they only ask about tamsulosin (Flomax) use.

    Clinical significance

    Every cataract surgeon should be aware of this data. Although we routinely consider IFIS with male patients, it is often overlooked in females. By recognizing the prevalence of this condition, operating room teams can now ask patients about their history of bladder medications. Since intraoperative complications are higher with IFIS, it is important to apply the same preventions strategies to female and male patients to maintain safe and efficient cataract surgery.