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  • Many factors can lead to intraoperative floppy iris syndrome during cataract surgery

    Cataract/Anterior Segment

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    Review of: Factors predisposing to intraoperative floppy-iris syndrome: An up-to-date meta-analysis

    Christou C, Esagian S, Ziakas N, et al. Journal of Cataract & Refractive Surgery, November 2022

    To provide insight the factors that increase the risk of intraoperative floppy iris syndrome (IFIS), a condition that can cause higher rates of complications during cataract surgery, investigators conducted a systematic review and meta-analysis of recent IFIS studies.

    Study design

    Inclusion criteria were: 1) studies published in English; 2) randomized clinic studies or nonrandomized observational studies; 3) studies with 2 arms. Thirty-eight studies were included in the analysis.

    Outcomes

    A meta-analysis of IFIS studies was first conducted 10 years ago; this updated analysis has found new statistically significant correlations between IFIS and decreased preoperative dilation, finasteride, benzodiazepines, and antipsychotic medications. Tamsulosin remains the major predisposing factor (odds ratio 31.06), but silodosin, a new selective α1-adrenoceptor antagonist (α1-ARA), is also linked to IFIS development and should be avoided in phakic patients. Interestingly, intracameral epinephrine was not found to significantly prevent the development of IFIS.

    Limitations

    Unadjusted odds ratios were reported in this meta-analysis, which may lead to bias since they do not account for co-exposure to other predisposing factors. No subanalysis was performed regarding predisposing factors and the IFIS severity.

    Clinical significance

    Findings from this analysis highlight that the number of medications that can cause IFIS has grown and now includes other classes of medications. As the patient population ages, the number of patients on α1-ARAs is likely to increase. Prophylactic agents for IFIS may include intracameral epinephrine, topical atropine, or nonsteroidal anti-inflammatory drugs; however, as these measures may not be as effective as once thought, other intraoperative interventions may still be necessary for a successful cataract surgery. 

    Financial Disclosures: Dr. Leela Raju discloses a financial relationship with RPS Diagnostics (Equity/Stock Holder - Private Corp).