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Paschon K, Szegedi S, Weingessel B, Fondi K, Huf W, Vécsei-Marlovits PV. Prospective analysis of anatomic features predisposing patients to intraoperative floppy iris syndrome. Graefes Arch Clin Exp Ophthalmol 2024; 262:103-111. [PMID: 37428221 DOI: 10.1007/s00417-023-06165-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/11/2023] Open
Abstract
PURPOSE To aid preoperative risk assessment by identifying anatomic parameters corresponding with a higher risk of intraoperative floppy iris syndrome (IFIS) during cataract surgery. METHODS Prospective cohort study of 55 patients with α1-adrenergic receptor antagonist (α1-ARA) treatment and 55 controls undergoing cataract surgery. Anterior segment optical coherence tomography (AS-OCT), video pupilometer, and biometry measurements were performed preoperatively and analyzed regarding anatomic parameters that corresponded with a higher rate of IFIS. Those statistically significant parameters were evaluated with logistic regression analysis and receiver operating characteristic (ROC) curve. RESULTS Pupil diameter was significantly smaller in patients who developed IFIS compared to those who did not develop IFIS (AS-OCT 3.29 ± 0.85 vs. 3.63 ± 0.68, p = 0.03; Pupilometer 3.56 ± 0,87 vs. 3.95 ± 0.67, p = 0.02). Biometric evaluation revealed shallower anterior chambers in the IFIS group (ACD 3.12 ± 0.40 vs. 3.32 ± 0.42, p = 0.02). Cutoff values for 50% IFIS probability (p = 0.5) were PD = 3.18 mm for pupil diameter and ACD = 2.93 mm for anterior chamber depth. ROC curves of combined parameters were calculated for α1-ARA medication with pupil diameter and anterior chamber depth, which yielded an AUC of 0.75 for all IFIS grades. CONCLUSION The combination of biometric parameters with history of α1-ARA medication can improve assessment of risk stratification for IFIS incidence during cataract surgery.
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Affiliation(s)
- Karin Paschon
- Department of Ophthalmology, Clinic Hietzing, Vienna Healthcare Group, Vienna, Austria
- Karl Landsteiner Institute of Process Optimization and Quality Management in Cataract Surgery, Clinic Hietzing, Vienna, Austria
- Zeiss Lab Vienna, Department of Medical Physics, Medical University of Vienna, Vienna, Austria
- Department of Ophthalmology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Stephan Szegedi
- Department of Ophthalmology, Clinic Hietzing, Vienna Healthcare Group, Vienna, Austria
- Karl Landsteiner Institute of Process Optimization and Quality Management in Cataract Surgery, Clinic Hietzing, Vienna, Austria
| | - Birgit Weingessel
- Department of Ophthalmology, Clinic Hietzing, Vienna Healthcare Group, Vienna, Austria
- Karl Landsteiner Institute of Process Optimization and Quality Management in Cataract Surgery, Clinic Hietzing, Vienna, Austria
| | - Klemens Fondi
- Karl Landsteiner Institute of Process Optimization and Quality Management in Cataract Surgery, Clinic Hietzing, Vienna, Austria
| | - Wolfgang Huf
- Karl Landsteiner Institute of Clinical Risk Management, Clinic Hietzing, Vienna, Austria
| | - Pia Veronika Vécsei-Marlovits
- Department of Ophthalmology, Clinic Hietzing, Vienna Healthcare Group, Vienna, Austria
- Karl Landsteiner Institute of Process Optimization and Quality Management in Cataract Surgery, Clinic Hietzing, Vienna, Austria
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Christou CD, Esagian SM, Ziakas N, Prousali E, Tzamalis A. Factors predisposing to intraoperative floppy-iris syndrome: An up-to-date meta-analysis. J Cataract Refract Surg 2022; 48:1335-1341. [PMID: 35858619 DOI: 10.1097/j.jcrs.0000000000001017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 07/15/2022] [Indexed: 11/26/2022]
Abstract
Intraoperative floppy-iris syndrome (IFIS) is an increasingly recognized condition that is proven to lead to higher rates of intraoperative complications. This study provides an updated systematic review and meta-analysis regarding all the identified factors predisposing to IFIS. The study was performed in accordance with the PRISMA guidelines. 38 studies were finally included in the meta-analysis. The factors that were found to predispose to IFIS significantly were male sex (odds ratio [OR], 4.25; CI, 2.58-7.01), hypertension (OR, 1.55; CI, 1.01-2.37), tamsulosin (OR, 31.06; CI, 13.74-70.22), finasteride (OR, 4.60; CI, 1.97-10.73), benzodiazepines (OR, 2.88; CI, 1.17-7.12), and antipsychotics intake (OR, 6.91; CI, 2.22-21.50). A decreased dilated pupil preoperatively was found predisposing to IFIS (weighted mean difference -0.93; CI, -1.19 to -0.67). Intracameral epinephrine, which was investigated as a potential prophylactic measure for preventing IFIS, did not reach statistical significance (OR, 0.29; CI, 0.08-1.06). A comprehensive preoperative assessment of all risk factors is vital to stratify the surgical risk, which is crucial in addressing IFIS because unanticipated IFIS could turn a routine surgery into one of significant visual morbidity.
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Affiliation(s)
- Chrysanthos D Christou
- From the 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
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Wen X, Li F, Liu F, Fan Z. A novel ratiometric sensor prepared based aggregation-induced emission for ultrafast detection of SO 2 derivatives in food samples and living cells. Anal Chim Acta 2022; 1229:340385. [PMID: 36156236 DOI: 10.1016/j.aca.2022.340385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/16/2022] [Accepted: 09/08/2022] [Indexed: 11/19/2022]
Abstract
As one of the gaseous signaling molecules, aberrant levels of SO2 are usually associated with many diseases. it is of great significance to develop sensitive methods for detection SO2 on real. In this paper, a D-π-A near-infrared aggregation-induced fluorescent probe (DPA-CN) was built using diphenylamino-4-benzaldehyde and malononitrile for sensing SO2. The DPA-CN exhibit AIE characterization that can quickly recognize SO2 via the Michael addition mechanism. The DPA-CN displayed emission blue drift from 650 nm to 560 nm after adding SO2, thereby realizing rapid and sensitive colorimetric detection of SO2. The mechanism for recognition of SO2 was verified via magnetic resonance imaging (1H NMR), electrospray ionization mass spectrometry (ESI-MS), scanning electron microscopy (SEM) and dynamic light scattering (DLS). The DPA-CN realized rapid and sensitive recognition of SO2 with high specificity in 10 s within the concentration range of 0-100 μM. The limit of detection (LOD) is as low as 0.31 μM. Owing to its high sensitivity and low toxicity, the DPA-CN can be applied in monitoring of SO2 in living cells and food analysis. Furthermore, the DPA-CN was used to prepare a visible and ultrafast semiquantitative paper-based SO2 sensor with low cost and easy operation.
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Affiliation(s)
- Xiaoye Wen
- Department of Chemistry, Shanxi Normal University, TaiYuan, 030006, China
| | - Fang Li
- Department of Chemistry, Shanxi Normal University, TaiYuan, 030006, China
| | - Furong Liu
- Department of Chemistry, Shanxi Normal University, TaiYuan, 030006, China
| | - Zhefeng Fan
- Department of Chemistry, Shanxi Normal University, TaiYuan, 030006, China.
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Selective chemodosimetric ‘Turn-On’ fluorescence sensor for HSO3−: Comparing the reactivity of the exocyclic vs. non-exocyclic C C double bond. J Photochem Photobiol A Chem 2022. [DOI: 10.1016/j.jphotochem.2021.113669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Park SSE, Wilkinson S, Mamalis N. Dealing with floppy iris syndrome. Curr Opin Ophthalmol 2022; 33:3-8. [PMID: 34711714 DOI: 10.1097/icu.0000000000000815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The aim of this study was to review and summarize recent findings and advancements regarding intraoperative floppy iris syndrome (IFIS). Although many improvements have been made for the management of IFIS, it remains a challenging condition for surgeons. An understanding of the syndrome as well as the multitude of tools to mitigate risk of complication is important for surgeons operating on high-risk patients. RECENT FINDINGS A variety of management approaches have been modified and improved or further supported with new data, such as intracameral compounds, intraoperative devices and surgical techniques. SUMMARY An understanding of risk factors is important for the identification of at-risk patients. A variety of approaches can greatly reduce incidence of IFIS complications. Multiple management strategies should be utilized to further reduce risk during these difficult surgeries.
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Affiliation(s)
- Sally S E Park
- John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
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Preoperative atropine and non-steroidal anti-inflammatory drugs for the prevention of intraoperative floppy iris syndrome. Graefes Arch Clin Exp Ophthalmol 2021; 260:893-900. [PMID: 34652535 DOI: 10.1007/s00417-021-05444-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 09/29/2021] [Accepted: 10/01/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To examine the efficacy of preoperative administration of topical atropine 1% and non-steroidal anti-inflammatory drugs (NSAIDs) for prevention of intraoperative floppy iris syndrome (IFIS). METHODS In this retrospective cohort study, patients who underwent cataract surgery by phacoemulsification between July 2019 and February 2020 in two hospitals were included. Both hospitals are located in central Israel, have similar patient demographics and employ similar surgical techniques. They, however, differ in policy of IFIS prevention. In Meir Medical Center no preventive medications are given pre-operatively, while in Shamir Medical Center patients at-risk for IFIS receive topical atropine 1% once daily and non-steroidal anti-inflammatory drugs (NSAIDs) thrice daily for 3 days preoperatively. RESULTS Overall, 207 eyes of 207 patients with history of alpha-antagonist use were included. Mean age was 74.9 ± 7.8 years and 82.1% (n = 170) were male. Among patients from the pretreating center 86.8% (n = 92/106) were pre-treated with either NSAIDs or atropine preoperatively, while in the non-pretreating center no treatment was prescribed (n = 0/101). IFIS rate among the non-pretreating center was 29.7% (n = 30/101) compared to 15.1% (n = 16/106) in the pretreating center (p = 0.012). When strictly comparing treated to untreated patients, the treated group had an IFIS rate of 12.0% compared to 30.4% among untreated (p = 0.001). Adjusted for age and gender results remain consistent (odds ratio 0.329 for treated patients, 95% confidence interval: 0.150-0.720; p = 0.005). CONCLUSIONS IFIS rates were significantly lower in the pretreating center compared to the non-pretreating center. When comparing strictly treated to untreated patients, differences were even more pronounced.
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Vural GS, Vural M. Predictive value of pupillography on intraoperative floppy iris syndrome in preoperative period. Int J Ophthalmol 2021; 14:1018-1024. [PMID: 34282386 DOI: 10.18240/ijo.2021.07.09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 02/25/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To present the frequency of intraoperative floppy iris syndrome (IFIS) in cataract patients who taking alpha 1-a receptor antagonist (ARA) drugs, and evaluate the predictive value of pupil diameter (PD) changes in IFIS patients. METHODS Male cataract patients who are under treatment with alpha-1a-ARAs (alfuzosin, tamsulosin) intraoperatively were evaluated and were grouped as with/without IFIS. The preoperative PD values were compared with controls. Also, the intraoperative manipulations and early/late complications were recorded. RESULTS A total of 77 patients (77 eyes) of 94 benign prostate hyperplasia (BPH) patients have been defined as IFIS (81.91%) and 40 patients (40 eyes) were taking tamsulosin and 37 patients (37 eyes) were taking alfuzosin. During the cataract surgery, the rate of posterior capsular rupture (P=0.754), vitreous loss (P=0.585), iris tears (P=0.004), and iris catching (P=0.000) were higher in IFIS group, but the difference was significant only in the iris catching. At the postoperative first-month visit, persistent IOP rise and iris stromal tears were more frequent in IFIS group, but the difference was not significant (P=0.311, P=0.146; respectively). In contrast, Descemet membrane detachment was insignificantly more frequent in controls (P=0.311). In IFIS and control patients, PDs were 9.54±1.78 and 9.72±1.57 mm (P=0.255) under scotopic illumination, 8.54±1.43 and 8.74±1.25 mm (P=0.289) under mesopic illumination, 6.99±1.35 and 7.27±1.39 mm (P=0.662) under photopic illumination, respectively. However PDs were lower in IFIS under all illumination degrees, no significant difference was detected between groups. CONCLUSION IFIS is a significant clinical syndrome with an increased intraoperative/postoperative complication ratio. The prediction of this syndrome is important because of prevention required precautions against possible complications. There is no association between IFIS and preoperative PD.
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Affiliation(s)
- Gozde Sahin Vural
- Department of Ophthalmology, Balikesir University Medicine Faculty, Balikesir 10100, Turkey
| | - Mehmet Vural
- Department of Ophthalmology, Balikesir Ataturk State Hospital, Balikesir 10020, Turkey
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García Del Valle I, Alvarez-Lorenzo C. Atropine in topical formulations for the management of anterior and posterior segment ocular diseases. Expert Opin Drug Deliv 2021; 18:1245-1260. [PMID: 33787441 DOI: 10.1080/17425247.2021.1909568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Atropine is an old-known drug which is gaining increasing attention due to the myriad of therapeutic effects it may trigger on eye structures. Nevertheless, novel applications may require more adequate topical formulations. AREAS COVERED This review aims to gather the existing knowledge about atropine and its clinical applications in the ophthalmological field when administered topically. Atropine ocular pharmacokinetics is paid a special attention, including recent evidences of the capability of the drug to access to the posterior segment. Ocular bioavailability and systemic bioavailability are counterbalanced. Finally, limitations of traditional dosage forms and potential advantages of under investigation delivery systems are analyzed. EXPERT OPINION Mydriasis and cyclopegia have been widely exploited for eye examination, management of anterior segment diseases, and more recently as antidotes of chemical weapons. Improved knowledge on drug receptors and related pathways explains atropine repositioning as an outstanding tool to prevent myopia. The ease with which atropine penetrates ocular tissues is a double edged sword, that is, while it ensures therapeutic levels in the posterior segment, the unspecific distribution causes a wide variety of untoward effects. The design of formulations that can selectively deliver atropine to the target tissue for each specific application is an urgent unmet need.
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Affiliation(s)
- Ines García Del Valle
- Departamento De Farmacología, Farmacia Y Tecnología Farmacéutica, I+D FarmaGroup, Facultad De Farmacia and Health Research Institute of Santiago De Compostela (IDIS), Universidade De Santiago De Compostela, Santiago De Compostela, Spain
| | - Carmen Alvarez-Lorenzo
- Departamento De Farmacología, Farmacia Y Tecnología Farmacéutica, I+D FarmaGroup, Facultad De Farmacia and Health Research Institute of Santiago De Compostela (IDIS), Universidade De Santiago De Compostela, Santiago De Compostela, Spain
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Tzamalis A, Christou CD, Tsinopoulos I, Ziakas N. Risk factors of floppy iris syndrome: current insights. EXPERT REVIEW OF OPHTHALMOLOGY 2021. [DOI: 10.1080/17469899.2021.1877539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Argyrios Tzamalis
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki Papageorgiou General Hospital, Thessaloniki, Greece
| | - Chrysanthos D. Christou
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki Papageorgiou General Hospital, Thessaloniki, Greece
| | - Ioannis Tsinopoulos
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki Papageorgiou General Hospital, Thessaloniki, Greece
| | - Nikolaos Ziakas
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki Papageorgiou General Hospital, Thessaloniki, Greece
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Sarkar S, Kasturi N, Bardoloi N. Minimizing topical medication in cataract surgery. TNOA JOURNAL OF OPHTHALMIC SCIENCE AND RESEARCH 2021. [DOI: 10.4103/tjosr.tjosr_61_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Yang X, Liu Z, Fan Z, Grzybowski A, Wang N. A narrative review of intraoperative floppy iris syndrome: an update 2020. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1546. [PMID: 33313291 PMCID: PMC7729334 DOI: 10.21037/atm-20-3214] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Intraoperative floppy iris syndrome (IFIS) is characterized by intraoperative floppiness or billowing of the iris, progressive miosis, and iris prolapse through the surgical wounds. It was originally reported about fifteen years ago, which was later identified to be closely associated with tamsulosin, the most commonly used α1 adrenoceptor antagonist for benign prostatic hyperplasia (BPH). A variety of risk factors, including age, gender, hypertension, axial length of the eye, 5α-reductase inhibitors, other α adrenoceptor antagonist and neuromodulators, have been connected with IFIS. If IFIS occurs during phacoemulsification surgery, complications such as corneal endothelial loss, iris trauma, posterior capsule rupture (PCR), high intraocular pressure and vitreous loss are significantly increased. Therefore, preoperative evaluation of high-risk patients and appropriate intraoperative intervention is crucial to avoid severe complications. This review summarizes the pathogenesis and clinical features of classic IFIS, and provides some clinical pearls to ophthalmologists that may help identify, prevent or reduce IFIS associated complications. Additionally, from the perspective of clinical occurrence of IFIS, there are some recommendations for urologists as well. In conclusion, both ophthalmologists and urologists should be aware of this special clinical situation and communicate with each other about their own fields. A multidisciplinary interaction is of importance to simplify potentially complicated clinical issues.
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Affiliation(s)
- Xue Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Zhaochuan Liu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
| | - Zhigang Fan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Andrzej Grzybowski
- Chair of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland.,Institute for Research in Ophthalmology, Poznan, Poland
| | - Ningli Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
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He X, Xu W, Ding F, Xu C, Li Y, Chen H, Shen J. Reaction-Based Ratiometric and Colorimetric Chemosensor for Bioimaging of Biosulfite in Live Cells, Zebrafish, and Food Samples. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2020; 68:11774-11781. [PMID: 32886514 DOI: 10.1021/acs.jafc.0c03983] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In this work, a reaction-based ratiometric and colorimetric sensor was designed and synthesized for probing bisulfite (HSO3-) by coupling coumarin (CM) with barbituric (BA) moiety. Further tests have shown that CM-BA has high selectivity and sensitivity for the recognition of HSO3-, which can be applied for the detection of HSO3- in environmental and biological systems very effectively. The fluorescence intensity ratios (F462/F568) exhibited an outstanding HSO3--dependent response with ultrafast response time (within 20 s) and a lower detection limit (105 nM). Meanwhile, the color of the CM-BA solution changed from green to colorless during the recognition process, and its fluorescence changed from green to blue. The mechanism of response is confirmed by the density functional theory (DFT) model. In summary, CM-BA has demonstrated low toxicity and good permeability, which can be applied for imaging HSO3- in cells and zebrafish safely and effectively. Besides, this novel sensor CM-BA successfully realized the quantification of the concentration of HSO3- in paper strips and food samples.
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Affiliation(s)
- Xiaojun He
- School of Ophthalmology & Optometry, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, Zhejiang 325035, China
| | - Wei Xu
- School of Ophthalmology & Optometry, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, Zhejiang 325035, China
| | - Feng Ding
- Department of Microbiology & Immunology, School of Basic Medical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang 325035, China
| | - Chuchu Xu
- School of Stomatology, Wenzhou Medical University, Wenzhou, Zhejiang 325035, China
| | - Yahui Li
- School of Ophthalmology & Optometry, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, Zhejiang 325035, China
| | - Hong Chen
- Luoyang Key Laboratory of Organic Functional Molecules, College of Food and Drug, Luoyang Normal University, Luoyang, Henan 471934, China
| | - Jianliang Shen
- School of Ophthalmology & Optometry, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, Zhejiang 325035, China
- Engineering Research Center of Clinical Functional Materials and Diagnosis & Treatment Devices of Zhejiang Province, Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang 325001, China
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Christou CD, Tsinopoulos I, Ziakas N, Tzamalis A. Intraoperative Floppy Iris Syndrome: Updated Perspectives. Clin Ophthalmol 2020; 14:463-471. [PMID: 32109982 PMCID: PMC7039091 DOI: 10.2147/opth.s221094] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 02/11/2020] [Indexed: 12/24/2022] Open
Abstract
Almost fifteen years since its initial description, intraoperative floppy iris syndrome (IFIS) during phacoemulsification surgery remains a challenge for cataract surgeons in all its key aspects that include the stratification of the preoperative risk, preoperative prophylaxis treatment, surgery design and intraoperative management. Since its original association with tamsulosin intake, IFIS has been positively correlated with a plethora of risk factors which include: gender, age, hypertension, other a1-adrenergic receptor antagonists, finasteride, angiotensin II receptor inhibitors, benzodiazepines, antipsychotics, hypertension drugs and decreased dilated pupil diameter. The assessment and stratification of the preoperative risk is pivotal in screening patients prone to develop IFIS. For these patients, it is essential that preoperative prophylaxis, employment of necessary measures and surgical technique modifications are considered. A multidisciplinary approach of IFIS is a mandate, thus ophthalmologists, urologists and sometimes other specialties should cooperate to “educate” each other about the risks of their respective fields. They both must be aware of the joint statement on IFIS by the American Academy of Ophthalmology and the American Society of Cataract and Refractive Surgery which suggests either the initiation of tamsulosin after phacoemulsification or the use of a non-selective a1-ARA for benign prostatic hyperplasia treatment. In conclusion, awareness of the risk factors associated with IFIS and their detailed preoperative documentation is crucial in addressing IFIS. The lack of such an awareness can turn a routine, uneventful surgery into one with significant visual morbidity.
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Affiliation(s)
- Chrysanthos D Christou
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Ioannis Tsinopoulos
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Nikolaos Ziakas
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Argyrios Tzamalis
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
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Abstract
PURPOSE OF REVIEW Routine prophylaxis for adverse events following cataract surgery is evolving. Prior reliance on topical eyedrop instillation by patients is giving way to surgeon directed injections at the time of cataract surgery. The benefit of this new approach is assured delivery of drugs in standardized doses which should optimize the healing process and reduce the incidence of untoward events with higher confidence. RECENT FINDINGS Adoption rates of intracameral antibiotic injection amongst European and American cataract surgeons is increasing. Techniques to inject periocular corticosteroid for routine inflammation prophylaxis are also in development. In combination with intraoperative pharmacologic dilation, a drop-free modality can be achieved. SUMMARY Intraoperative injections offer the patient and surgeon assured drug delivery and hold promise to avoid the pitfalls of patient adherence, incorrect topical instillation, and topical drop-associated corneal issues.
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Affiliation(s)
- Neal H Shorstein
- Departments of Ophthalmology and Quality, Shorstein - Kaiser Permanente, Oakland, California; Department of Ophthalmology, Myers - Northwestern University, Chicago, IL
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