• Written By: Lisa B. Arbisser, MD
    Cataract/Anterior Segment

    This prospective study found that intracameral phenylephrine (IPH) is a highly efficient tool for prophylaxis against intraoperative floppy iris syndrome (IFIS). Moreover, it can reverse IFIS, restoring iris rigidity and causing the pupil to return to its preoperative size.

    This is a very important paper as IPH can markedly cut down on the need for Malyugin Rings and reducecosts. The question is how we make it work given the compounding restrictions on surgery centers.

    Subjects were 42 patients receiving tamsulosin who underwent cataract surgery between January and April 2011 at one of two sites and by one of two experienced surgeons. One eye of each patient was randomized to receive 0.6 ml of nonpreserved bisulfite-free IPH 1.5% or balanced saline solution (BSS) at the start of surgery, with the second eye automatically assigned to other group. If significant miosis or iris prolapse occurred, IPH was injected during phacoemulsification in eyes that received BSS.

    Signs of IFIS were observed in 88 percent of eyes that received BSS compared to none of the eyes that received IPH (P < 0.001). Significant miosis, iris prolapse, or both occurred in 55 percent of eyes that received BSS, but the condition reverted with IPH, with a significant increase in pupil size after IPH administration (from 4.77 ±0 .88 mm to 6.68 ± 0.93 mm; P = 0.000).

    No intraoperative complications occurred. No significant differences in endothelial cell count, BCVA, or IOP were detected between IPH-treated and nontreated eyes. Blood pressure/pulse rate did not differ significantly from preoperative values in IPH-treated cases.

    The authors note that intracameral phenylephrine has several advantages over other agents considered for IFIS prophylaxis. It is simpler, less traumatic, and quicker than placing iris hooks. The solution is easy to prepare and can be stored for up to two months at room temperature in the operating room.

    They conclude that the absence of IFIS manifestations among the eyes receiving phenylephrine at the beginning of surgery and the ability of phenylephrine to reverse IFIS once it occurred demonstrate that IPH 1.5 % is a simple, efficient measure for prophylaxis and management of IFIS.