Chicago—Intraoperative floppy iris syndrome (IFIS) can result in a high complication rate when unanticipated, but with a simple preoperative medication history, cataract surgeons can now predict when this problem may occur, said David F. Chang, MD, in the “Spotlight on Cataract Surgery 2005” session held during the annual meeting of the American Academy of Ophthalmology.

IFIS is characterized by the clinical triad of initial billowing and flopping of the iris in response to normal irrigation currents in the anterior chamber, repeated iris prolapse to the incisions, and progressive miosis.

Based on retrospective observations, John Campbell, MD, first related IFIS to patient use of the alpha-1a selective adrenoreceptor antagonist tamsulosin (FloMax, Boehringer Ingelheim). Subsequent studies by Dr. Campbell and Dr. Chang corroborated that association and showed that IFIS was associated with a high rate of posterior capsular rupture. Their experience also indicated that traditional methods for managing small pupils, including partial thickness sphincterotomies and mechanical pupil stretching, were ineffective in eyes with IFIS.

Alternatives that have been found useful for maintaining pupil dilation and blocking iris prolapse to the incision include viscomydriasis with Healon 5 (AMO), use of ophthalmic viscosurgical devices in an ultra-soft shell technique, insertion of pupil expansion rings, and placement of iris retractors in a diamond configuration.

Now preliminary results of a multicenter prospective trial involving 169 consecutive patients currently on tamsulosin show promise that good outcomes are possible when at-risk patients are identified preoperatively and appropriate intraoperative strategies are employed.

“Tamsulosin is the most commonly prescribed drug in the United States for treating men with benign prostatic hypertrophy, and so it is important that cataract surgeons be aware of this new syndrome of IFIS,” Dr. Chang said.