Abstract
PurposeTo detect any choroidal thickness (CT) change in patients after alpha-lytic drugs withdrawal that could help in the cataract surgery timing decision.MethodsTwenty-five eyes of 25 patients (mean age: 76 ± 7 years) under alpha-lytic therapy, and 25 eyes of 25 control subjects (CS) (mean age: 75 ± 7 years) without alpha-lytic therapy, both scheduled for cataract surgery in the fellow eye, were included in this observational, prospective, non-randomized study. All patients underwent EDI-OCT during the first preoperative visit and approximately 1 month (range 28–31 days) after alpha-lytic withdrawal. In the CS group, the OCT during preoperative visit and approximately 1 month after (range 28–31 days) the first examination was performed. Data normality with Kolmogorov-Smirnov test was checked and statistical evaluation with the Wilcoxon-signed rank test was performed.ResultsThe mean subfoveal CT was 224 ± 79.7 μm during therapy and 217 ± 70.4 μm after withdrawal; 1.5 mm nasally from the fovea CT was 198 ± 83.8 μm and 194 ± 82.8 μm, respectively; and 1.5 mm temporally from the fovea CT was 217 ± 55.9 μm and 205 ± 54.4 μm, respectively. A statistically significant reduction (p < 0.05) in all the 3 measured CT points was found. In the CS no significant changes were detected (p > 0.05).ConclusionNo severe floppy iris syndrome was detected at the time of surgery. In these patients, CT decrease could be an important sign for cataract surgery timing decision.
Highlights
Cataract represents the leading cause of blindness worldwide [1]
Ophthalmologists must be aware of intraoperative floppy iris syndrome (IFIS) because it is associated with high rates of intraoperative complications, such as iris prolapse, capsulorhexis tear, iris trauma, anterior chamber hemorrhage, zonula dehiscence, posterior capsule rupture, and vitreous loss, as well as postoperative complications, including intraocular pressure elevation and cystoid macular edema [4, 5]
As the whole uvea could be involved in the drug-induced modifications, the purpose of this study was to check if such a withdrawal could produce choroidal thickness (CT) changes
Summary
Sympathetic system, through noradrenaline release, induces radial iris muscle contraction and subsequent pupil dilation (mydriasis). Several drugs, such as selective α1 adrenergic receptor antagonists (ARA) inhibitors, can Ophthalmologists must be aware of IFIS because it is associated with high rates of intraoperative complications, such as iris prolapse, capsulorhexis tear, iris trauma, anterior chamber hemorrhage, zonula dehiscence, posterior capsule rupture, and vitreous loss, as well as postoperative complications, including intraocular pressure elevation and cystoid macular edema [4, 5]. To try to avoid the IFIS onset, the withdrawal of selective α1ARA inhibitors before surgery has been suggested Such discontinuation is not always effective and no objective preoperative signs, which help to forecast the success in avoiding IFIS have been described
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