July 2019
Volume 60, Issue 9
ARVO Annual Meeting Abstract  |   July 2019
Incidence of postoperative complications after cataract surgery with intraoperative floppy iris syndrome
Author Affiliations & Notes
  • Frini Makadia
    Vanderbilt Eye Institute, Nashville, Tennessee, United States
  • Mary K Daly
    Department of Ophthalmology, VA Boston Healthcare System, Boston, Massachusetts, United States
  • David Vollman
    Department of Ophthalmology, VA St. Louis Healthcare System, St. Louis, Missouri, United States
    Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, United States
  • Qingxia Chen
    Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, United States
  • Amy Chomsky
    Department of Ophthalmology, VA Tennessee Valley Healthcare System, Nashville, Tennessee, United States
    Vanderbilt Eye Institute, Nashville, Tennessee, United States
  • Footnotes
    Commercial Relationships   Frini Makadia, None; Mary Daly, None; David Vollman, None; Qingxia Chen, None; Amy Chomsky, None
  • Footnotes
    Support  n/a
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 502. doi:
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      Frini Makadia, Mary K Daly, David Vollman, Qingxia Chen, Amy Chomsky; Incidence of postoperative complications after cataract surgery with intraoperative floppy iris syndrome. Invest. Ophthalmol. Vis. Sci. 2019;60(9):502.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose : Selective and nonselective alpha-blockers (AB) are commonly utilized in the Veterans Health Administration System for benign prostatic hypertrophy and have been implicated in the development of intraoperative floppy iris syndrome (IFIS). Patients with IFIS have an increased risk of developing intraoperative complications. We performed a retrospective analysis of cataract surgery cases with IFIS from the Veterans Affairs (VA) Ophthalmic Surgical Outcomes Data Project and the incidence of postoperative structural complications.

Methods : Surgical outcomes from 4,923 phacoemulsification cases performed at 5 VA hospitals were analyzed. Outcomes of patients on selective or nonselective AB with IFIS were compared with those of patients on AB without IFIS. Patients with pre-existing iris trauma were excluded. Postoperative outcomes included best corrected visual acuity (BCVA), corneal stromal edema, inflammation noted at postoperative month one, cystoid macular edema (CME), and retained lenticular material. Results were adjusted for a preoperative history of uveitis, prostaglandin use, findings of corneal guttae, or CME. P values were calculated using the χ2 test.

Results : A total of 1,155 patients took preoperative AB; 151 of these patients developed IFIS. BCVA was 0.158 ± 0.36 LogMAR (20/28) in patients with IFIS vs 0.097 ± 0.25 (20/25) in patients without IFIS (p = 0.03). Upon adjusting for preoperative findings of corneal guttae, 11 (7%) patients with IFIS developed corneal stromal edema versus 54 (5%) patients without IFIS (p = 0.34). Intraocular inflammation marked by either cell or flare was found in 21 (14%) patients with IFIS versus 158 (16%) without IFIS (p = 0.59) after adjusting for preoperative findings of uveitis or inflammation. Five (3%) patients with IFIS were found to have CME after adjusting for preoperative findings of CME, uveitis, or use of prostaglandins. Six (4%) of patients with IFIS were found to have retained lenticular material postoperatively versus 21 (2%) patients without IFIS (p = 0.15).

Conclusions : Patients on AB with IFIS do not exhibit a higher incidence of postoperative complications when compared to patients on AB alone. Rates of corneal stromal edema, intraocular inflammation, CME, and retained lenticular material occur at similar rates in both groups. The significant BCVA decrease in IFIS patients will require further investigation.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.



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