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Asher Neren, Andrew Greenberg, Eitan Burstein, Chirantan Mukhopadhyay, Amilia Schrier, Edward Smith; A Comparison of the Outcomes of Resident-Performed Phacoemulsification in Patients on Alpha Blockers Before and After the Description of Floppy Iris Syndrome (IFIS). Invest. Ophthalmol. Vis. Sci. 2012;53(14):6710.
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To determine whether the description of Intraoperative Floppy Iris Syndrome (IFIS) in 2005 (1) affected the rates of vitreous loss in patients treated with alpha receptor antagonists who underwent resident-performed phacoemulsification.
A retrospective chart review of 1308 patients who had undergone 1621 consecutive resident-performed phacoemulsification cataract extraction procedures at the Department of Veterans Affairs New York Harbor Healthcare System Brooklyn between January 2000 and June 2010 was performed. Four hundred fourty three (443) procedures were performed on patients exposed to alpha receptor antagonists. The most frequently used alpha blockers in our patient population were tamsulosin, terazosin, and prazosin. Vitreous loss and best corrected visual acuity were compared in patients pre and post the description of IFIS. Group I included all alpha receptor blocked patients from January 1, 2000 to April 30, 2005 and Group II from May 1, 2005 to June 30, 2010. The results from the two groups of patients were compared.
The rate of vitreous loss in alpha receptor treated eyes was 11.6 % (25/215) for Group I and 3.5% (8/228) in Group II. The probability of achieving a best corrected visual acuity of 20/40 or better in the post-operative period was 82.7 % (178/215) in Group 1 vs. 88.1% (201/228) in Group II.
A marked reduction in the rate of vitreous loss and increased likelihood of improvement in BCVA >20/40 was found in alpha receptor treated eyes after April 2005 (Group II). We believe that the improved outcomes are a result of heightened awareness of intraoperative floppy iris syndrome, implementation of IFIS prophylaxis techniques including preoperative atropine, intracameral epinephrine, the use of iris stabilization devices (such as iris hooks and Malyugin rings) and improved phacoemulsification techniques. The description of IFIS and implementation of prophylactic measures have resulted in improved outcomes in resident performed phacoemulsification in patients exposed to alpha receptor blockers.(1). Chang DF, Campbell JR. Intraoperative floppy iris syndrome associated with tamsulosin. J Cataract Refract Surg. 2005;31(4):664-673.
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