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Cynthia I. Tung, Gianmarco Vizzeri, Brent Lum, Thomas C. Prager, Joseph M. George, Oday J. Alsheikh; Hypertension Complicated by Cardiovascular Disease is an Important Risk Factor for the Development of Intraoperative Floppy Iris Syndrome. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6682.
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Previous studies show that intraoperative floppy-iris syndrome (IFIS) is associated with multiple risk factors including systemic diseases and medications. In this study, we evaluate the association between IFIS and hypertension complicated by different cardiovascular diseases.
200 eyes of 144 patients that underwent phacoemulsification by one surgeon over a 1-year period were included in this retrospective study. A systematic grading scheme was used to identify IFIS. The percentage of eyes that developed IFIS was calculated for each category of disease: eyes of patients without systemic disease, eyes of patients with hypertension alone, and eyes of patients with hypertension complicated by different cardiovascular diseases. The percentage of eyes that developed IFIS was also calculated for hypertensive patients taking tamsulosin. Comparison among different diseases was made using one-way ANOVA followed by Tukey multiple-comparisons test.
Hypertension was significantly associated with IFIS (p < 0.05). The risk for developing IFIS in patients with hypertension (37.8%) increased more than two fold compared to the risk for developing IFIS in patients without hypertension (15.4%). More interestingly, IFIS showed strong association with hypertension complicated by different cardiovascular diseases compared to hypertension alone (p < 0.05). For example, a high percentage of IFIS developed in eyes of patients with hypertension complicated by coronary artery and peripheral vascular disease (65.2%), atrial fibrillation (75%), congestive heart failure (63.6%), aortic valve stenosis (50%), and a history of coronary artery bypass graft (50%). ANOVA analysis yielded statistical significance among the different cardiovascular diseases (p < 0.05). IFIS developed in all hypertensive patients taking Flomax (100%).
Our study indicates that hypertension complicated by cardiovascular disease is an important risk factor for developing IFIS. Therefore, careful preoperative screening for systemic cardiovascular disease in the setting of hypertension is important for predicting the likelihood of developing IFIS during cataract surgery.
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