June 2013
Volume 54, Issue 15
ARVO Annual Meeting Abstract  |   June 2013
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
Author Affiliations & Notes
  • David Vollman
    Ophthalmology and Visual Sceinces, Washington University School of Medicine, St. Louis, MO
    St. Louis VA Medical Center, St. Louis, MO
  • Amy Chomsky
    Vanderbilt Eye Institute, Vanderbilt University School of Medicine, Nashville, TN
    VA Tennessee Valley Healthcare System Center, Nashville, TN
  • Elizabeth Baze
    Michael E. DeBakey VA Medical Center, Houston, TX
    Cullen Eye Institute, Baylor College of Medicine, Houston, TX
  • Mary Daly
    VA Boston Healthcare System, Boston, MA
    Boston University School of Medicine, Boston, MA
  • Mary Lawrence
    VA/DoD Vision Center of Excellence, Washington D.C., DC
  • Footnotes
    Commercial Relationships David Vollman, None; Amy Chomsky, None; Elizabeth Baze, None; Mary Daly, None; Mary Lawrence, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2013, Vol.54, 1826. doi:
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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)

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Purpose: To determine rates of untoward events during cataract surgery with the use of pupillary expansion devices and intra-operative floppy iris (IFIS).

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: 743 treatment outcomes of cataract surgery • 445 cataract • 462 clinical (human) or epidemiologic studies: outcomes/complications  

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