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Management Techniques Lower Intraoperative Floppy Iris Syndrome Complication Rate: Presented at AAO

By K.L. Capozza

LAS VEGAS, NV -- November 16, 2006 -- The rate of intraoperative floppy iris syndrome (IFIS) in patients undergoing cataract extraction procedures can be reduced.

Intraoperative floppy iris syndrome is a complication that sometimes occurs during cataract extraction. Studies have shown that when IFIS is not expected, the syndrome can lead to a high capsule rupture rate. But if IFIS can be anticipated, the complication rate can be lowered and more easily managed, according to research presented here at the American Academy of Ophthalmology Annual Meeting (AAO).

Investigator David F. Chang, MD, clinical professor of ophthalmology, University of California, San Francisco School of Medicine, San Francisco, California, presented the findings on November 14^th.

Dr. Chang's study followed 167 consecutive patients taking tamsulosin (Flomax), a prostate drug linked to IFIS. Flomax blocks the dilator muscle in the iris, and during cataract surgery the pupil needs to be dilated. When the muscle fails to dilate, IFIS can occur.

The subjects were prospectively enrolled at 10 study sites and were randomized to receive 1 of 4 management techniques: preoperative atropine (5%), iris retractors (38%), pupil expansion ring (5%), and Healon 5 (52%).

The results showed that all patients had a low rate of ruptured posterior capsule (0.6%) and 95% achieved 20/40 or greater BCVA.

All management techniques were effective, Dr. Chang said. However, "more than half of atropine eyes needed another strategy -- meaning that atropine alone was usually not enough," he added.

The study did not assess the relative efficacy of the different techniques. "We did not try to prove superiority of 1 method over another, but recommend that complimentary strategies can be combined," Dr. Chang notes.

The complication rate was low when experienced surgeons could anticipate IFIS and utilize appropriate management strategies, he concluded.


[Presentation title: Complication Rate in Intraoperative Floppy Iris Syndrome Due to Tamsulosin: A Multicenter Prospective Study. PA078]

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