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F. D. Ford, S. Shin, C. Cowan, R. A. Copeland; Surgical Technique for Management of Intraoperative Floppy Iris Syndrome. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5668.
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Surgical complications related to intraoperative floppy iris syndrome (IFIS) are associated with the use of systemic alpha-1 adrenergic antagonists. Several methods have been described to combat this phenomenon. To date, one study has compared some of these methods to determine effectiveness in managing IFIS in patients on tamsulosin. The aim of this study is to further delineate the effectiveness of available techniques for combating IFIS in patients taking the alpha blocking agents, tamsulosin, alfuzosin, terazosin and doxazosin. We will evaluate surgical outcomes and rates of complications associated with each method. Our goal is to determine which, if any, technique decreases complications most consistently and if any one technique can be deemed safer than others.
An on-going prospective randomized observational series is presently underway to compare pharmacologic and surgical strategies currently used for controlling IFIS in patients on alpha blocking agents. Patients consented to undergo phacoemulsification also taking a systemic alpha antagonist are eligible for enrollment in the study. Four techniques: pre-operative atropine, iris retractors, viscosurgical device or intracameral epinephrine are randomly assigned at the time of study consent. The rate of operative and postoperative complications, severity of IFIS as described by David Chang, length of operating time, adjunctive techniques used to establish control and final visual acuity are being tabulated as outcome measures relating to ease of control of floppy iris using one of four methods.
Seven consecutive eyes in 7 patients taking an alpha-blocking agent have been enrolled. Three patients showed no IFIS (43%), 2 patients showed severe manifestations of IFIS (25%) 1 patient showed mild manifestations and 1 patient showed moderate manifestations. Both patients designated as severe had significant postoperative iris atrophy and corectopia with post-operative day 1 visual acuity of 20/80 or better. One of those patients also had a posterior capsule rent without vitreous loss.
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