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I. Hsu, L. Park; Intraoperative Floppy Iris Syndrome in a Patient on Systemic Tamsulosin (Flomax): A Case Report and Discussion of Intraoperative Techniqes . Invest. Ophthalmol. Vis. Sci. 2006;47(13):671.
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To report the case of a 65–year–old Chinese male with a history of diabetes mellitus on insulin, CAD, CVA, HTN, and BPH on tamsulosin who presented for bilateral cataract extraction complicated by intraoperative floppy iris during both operative procedures.
During the first cataract operation of the right eye, a generous amount of Healon GV was used to mechanically expand the pupil and block the iris from prolasping to the incisions. An Alcon SA60AT lens was injected into the capsular bag. Prior to the second operation, the patient was placed on ketorolac for two weeks and tamsulosin was temporarily discontinued for one week. This time, iris hooks were employed in the left eye in order to maintain an enlarged pupil diameter intraoperatively and contain the floppy iris from prolapsing into the wounds. An Alcon MA60AC lens was folded and inserted into the capsular bag.
First described by Chang and Campbell, a triad of characteristic intraoperative features distinguish the intraoperative floppy iris syndrome (IFIS). A flaccid iris stroma that undulates and billows in response to ordinary intraocular fluid currents; a propensity for the floppy iris stroma to prolapse toward the phaco and side–port incision despite proper wound construction; and progressive intraoperative pupil constriction despite standared preopertative pharmacologic measure designed to prevent this (topical cyclopentolate, phenylephrine, and nonsteroidal anti–inflammatory medications).1 A recent article by Gurbaxani and Packard described the use of intracameral phenylephrine to prevent the effects of floppy iris syndrome during cataract surgery.2 In conclusion, multiple techniques may be employed to address IFIS, but awareness and recognition of the ocular side effects of this systemic medication are most important in the assessment for cataract surgery. 1 Chang, DF, Campbell JR. Intraoperative floppy iris syndrome associated with tamsulosin. J Cataract Refract Surg 2005; 31:664–673. 2 Gurbaxani A, Packard R. Intracameral phenylephrine to prevent floppy iris syndrome during cataract surgery in patients on tamsulosin. Eye November 2005: 19(11).
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