Incidence of intra-operative floppy iris syndrome in a UK district general hospital and implications for future workload

Abstract

IFIS is a recently described condition observed during cataract surgery. However, its true incidence in the U.K. population is unknown. Our aim was to assess the incidence of IFIS associated with tamsulosin in patients undergoing cataract surgery in a U.K. district general hospital. A prospective observational study of patients on tamsulosin undergoing cataract surgery was carried out over a six month period to determine the incidence of IFIS and to document outcomes of those cases. The patients were identified during routine pre-operative assessment. 1462 cataract cases were performed over six months. From these cases, 23 eyes of 16 patients who were taking Tamsulosin were recruited into the study. All the patients were men and the mean age was 76 years. A small pupil was demonstrated intra-operatively in 69% (16/23) of the eyes. A floppy iris or iris prolapse during surgery was noted in 57% (13/23) of the eyes. Complications reported included posterior capsule rupture in one case (4%) and iris trauma in five cases (22%). A best corrected visual acuity of 6/9 or better was achieved in 21/23 cases. The incidence of IFIS in patients undergoing cataract surgery over six months is 0.9%. IFIS appears to be strongly associated with tamsulosin use. The increasing use ofthis drug in the elderly male population is likely to increase the workload on our cataract service. Prospective risk stratification for such patients to be operated by senior surgeons is therefore recommended.