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David Vollman, Amy Chomsky, Elizabeth Baze, Mary Daly, Mary Lawrence; Impact of intra-operative floppy iris and use of pupillary expansion devices on intra-operative complication rates in cataract surgery: results of the Ophthalmic Surgical Outcomes Data Project. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1826.
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© ARVO (1962-2015); The Authors (2016-present)
To determine rates of untoward events during cataract surgery with the use of pupillary expansion devices and intra-operative floppy iris (IFIS).
Retrospective analysis of 4,923 cataract surgery cases from the VA Ophthalmic Surgical Outcomes Data Project. Outcomes analyzed included use of alpha-blockers (both selective and non-selective), intraoperative floppy iris (IFIS), intraoperative iris trauma, intraoperative iris prolapse, posterior capsular tear, anterior capsule tear, intraoperative vitreous prolapse, and use of pupillary expansion devices. P-values were calculated using the Fisher exact test.
1,294 patients (26.3%) took alpha-blockers pre-operatively (selective 627, non-selective 667). Of these 1,294 patients, 428 patients (33.1%) had documented IFIS. However, 75.2% of patients with IFIS (428/569) had taken alpha-blockers pre-operatively (p<0.00001). 430 patients (8.7%) had a pupillary expansion device used during their cataract surgery of which 186 patients had IFIS (43.3%) (p<0.0001). 17 patients had anterior and posterior capsule tears (3.0%) of which 5 patients had both. 88.2% (15/17) of patients with posterior capsule tear had vitreous prolapse which required vitrectomy of which only 4 used a pupillary expansion device (23.5%). 38 patients with IFIS had at least one intra-operative complication and 18 patients with IFIS had more than one intra-operative complication (p<0.00001). Of these 18 patients with IFIS and more than one intra-operative complication, 27.8% (5/18) had pupillary expansion devices used.
The use of either selective or non-selective alpha-blockers pre-operatively demonstrated a significant risk of IFIS. Less than half of IFIS patients had pupillary expansion devices used during their cases. Approximately half of patients with intra-operative surgical complications and IFIS incurred more than one complication. A prospective trial could be conducted looking at whether the increased use of pupillary expansion devices in high-risk VA patients could decrease intra-operative surgical complication rates.
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