Intraoperative floppy iris syndrome – epidemiology and clinical assessment.

Abstract

Purpose: To assess the incidence, and to identify medications and clinical features associated with intraoperative floppy iris syndrome in patients undergoing cataract surgery. Material and methods: The non-randomized, observational, prospective study was performed in 616 eyes (610 patients) after cataract surgery to determine the incidence of intraoperative floppy iris syndrome and the medications associated with itshigher prevalence. We used a slit lamp adapted optical coherence tomography to evaluate anterior segment of 155 eyes (154patients), measuring pupil diameter before and after the use of mydriatics and assessing the pre-dilated iris thickness at thedilator and sphincter muscle region. Results: The overall incidence of intraoperative floppy iris syndrome was 4% (25/616 eyes). The highest prevalence of intraoperative floppy iris syndrome was shown in patients exposed to tamsulosin (39%). Pupil diameter in mm before and after mydriasis was significantly smaller in patients with intraoperative floppy iris syndrome as compared to the syndrome-free ones (pre-dilated – 1.85 ± 0.43 vs. 2.16 ± 0.37; p < 0.01; dilated – 5.04 ± 1.01 vs. 5.70 ± 0.87; p < 0.01). The thickness of the iris insphincter muscle region in µm was similar in patients with and without intraoperative floppy iris syndrome (520.3 ± 76.1 vs.520.6 ± 72.4; p > 0.05). Significantly thinner iris in dilator muscle region was found in patients with intraoperative floppy iris syndrome as compared to the syndrome-free ones (409.9 ± 55.7 vs. 448.6 ± 55.8; p < 0.05). The presence of intraoperative floppy iris syndrome was correlated with a higher risk of intraoperative complications. Conclusions: Patients with intraoperative floppy iris syndrome have decreased pupil diameter and a thinner iris in dilator muscle region. Slit lamp optical coherence tomography is a useful device to preoperatively detect clinical features associated with intraoperative floppy iris syndrome. These findings may warn the surgeon of potential intra-operative difficulties. Słowa kluczowe: zespół śródoperacyjnie wiotkiej tęczówki (IFIS), epidemiologia, operacja zaćmy, optyczna koherentna tomografia skojarzona z lampą szczelinową (sl-OCT).