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A. A. Chen, M. C. Wu, J. P. Kelly, A. Bhandari; Intraoperative Floppy-Iris Syndrome Prophylaxis and Preoperative Dilated Pupil Diameter: A Retrospective Study. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5584.
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To determine (1) the reported incidence of intraoperative floppy-iris syndrome (IFIS) among patients taking tamsulosin who undergo cataract extraction and (2) the reported incidence of IFIS among patients taking tamsulosin who receive prophylactic intracameral lidocaine/epinephrine (ILE) during cataract extraction.
IRB approval for this study was obtained from the University of Washington. Power calculations were performed. Ophthalmology clinic notes and medication lists of 1163 consecutive patients who underwent cataract extraction at a single center between January 2005 and July 2008 were reviewed. Of these, 81 patients were noted to have been on tamsulosin at the time of surgery; operative notes for these patients were reviewed. Preoperative dilated pupil diameter, use of prophylactic ILE after paracentesis construction, and presence of billowing iris, iris prolapse, and/or pupil constriction were recorded for each subject.
Mean age of subjects was 76.5 years, SD 7.6. Of these subjects, 26 of 81 (32.1%) received prophylactic ILE. With IFIS defined as the occurrence of any of the three phenomena constituting this syndrome (billowing iris, iris prolapse, or pupil constriction), the overall incidence of IFIS was 29.6%. Among those who did not receive prophylactic ILE, the incidence of IFIS was 25.4%. Among those who received prophylactic ILE, the incidence of IFIS was 38.5%. Use of prophylactic ILE did not decrease the incidence of IFIS (P = 0.174 by Fisher's Exact Test). Preoperative dilated pupil diameter was reported in 75 of 81 operative notes. Mean preoperative dilated pupil diameter was 6.6 mm, SD 1.3. With a small preoperative dilated pupil defined as less than 6.5 mm in diameter, 29 of 75 preoperative dilated pupils (38.7%) were reported as small. Among patients with small preoperative dilated pupils, the incidence of intraoperative pupil constriction was 37.9%. Among those with large preoperative dilated pupils, the incidence of intraoperative pupil constriction was 13.0%. The presence of a small preoperative dilated pupil was significantly associated with intraoperative pupil constriction (P = 0.014 by Fisher's Exact Test).
In this retrospective study of patients taking tamsulosin who undergo cataract extraction, the reported incidence of IFIS was 29.6%. This incidence is lower than previously reported values. The use of prophylactic intracameral lidocaine/epinephrine did not reduce the incidence of IFIS. Finally, data analysis beyond the original objectives showed a significant association between preoperative dilated pupil diameters less than 6.5 mm and intraoperative pupil constriction.
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