Incidence and Risk Factors of Intraoperative Floppy Iris Syndrome During Cataract Surgery

Ho Gyun Park; Sangkyung Choi

doi:10.3341/jkos.2014.55.1.73

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Park and Choi: Incidence and Risk Factors of Intraoperative Floppy Iris Syndrome During Cataract Surgery

Original Article

J Korean Ophthalmol Soc 2014;55(1):73-78.

Published online: 7 September 2014

DOI: https://doi.org/10.3341/jkos.2014.55.1.73

Incidence and Risk Factors of Intraoperative Floppy Iris Syndrome During Cataract Surgery

Ho Gyun Park, MD, Sangkyung Choi, MD

Department of Ophthalmology, Veterans Health Service Medical Center, Seoul, Korea

Address reprint requests to Sangkyung Choi, MD Department of Ophthalmology, Veterans Health Service Medical Center, #53 Jinhwangdo-ro 61-gil, Gangdong-gu, Seoul 134-791, Korea, Tel: 82-2-2225-1382, Fax: 82-2-2225-1485, E-mail: drskchoi@hanmail.net

Received 8 June 201314 August 2013 Accepted 20 November 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To determine the incidence and risk factors of intraoperative floppy iris syndrome (IFIS) in patients undergoing cataract surgery.

Methods

The present study included 981 eyes of 655 patients who underwent cataract surgery and development and grade of IFIS were recorded. Correlation analysis was performed to determine the relationship between the IFIS and risk factors such as α_1-adrenergic antagonist (tamsulosin, terazosin, alfuzosin), benzodiazepine, 5-α-reductase inhibitor, age, gender, hypertension, diabetes and glaucoma.

Results

IFIS developed in 178 eyes (18.1%) out of 981 eyes. There was a correlation between the development of the IFIS and α_1-adrenergic antagonist and benzodiazepine and male gender; however, there was no correlation with 5-α-reductase inhibitor, age, gender, hypertension, diabetes and glaucoma. IFIS grade tended to be higher as the cumulative dosage of the α_1-adrenergic antagonist increased. Odds ratio of the patients using tamsulosin was the highest among the other risk factors, which was 3.8 times higher than the patients using terazosin, 9.0 times higher than the patients using alfuzosin and 11.1 times higher than the patients using benzodiazepine. Among patients who underwent cataract surgery on both eyes and who were confirmed with IFIS in 1 or both eyes, no significant grade differences between the 2 eyes were noted.

Conclusions

Alpha 1-adrenergic antagonist and benzodiazepine were risk factors for the development of the IFIS, and as the cumulative dosage of the α_1-adrenergic antagonist increased, the probability of developing a higher grade of IFIS increased. Therefore, predicting and preparing for potential IFIS in patients who have the above-mentioned risk factors are necessary before planning cataract surgery. Additionally, the IFIS aspect of the first eye could be utilized as a predictive value for developing IFIS profile of the fellow eye.

Keywords: Alpha 1-adrenergic antagonist, Benzodiazepine, Cataract surgery, Intraoperative floppy iris syndrome

References

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Table 1.

Demographic characteristics of patients (655 patients, 981 eyes)

	IFIS (n = 178)	Non-IFIS (n = 803)	All subjects (n = 981)
Age (years)	73.1 ± 7.7	73.3 ± 7.1	73.1 ± 7.8
Sex
Male	175 (98.3%)	582 (72.4%)	757 (77.2%)
Female	3 (1.7%)	221 (27.6%)	224 (22.8%)

Values are presented as mean ± SD.

IFIS = intraoperative floppy iris syndrome; SD = standard deviation.

Table 2.

Profile of intraoperative floppy iris syndrome grade

	Grade 1 (%)	Grade 2 (%)	Grade 3 (%)	Total
IFIS, eyes	111 (62.4)	36 (20.2)	31 (17.4)	178
α-adrenergic antagonist	96 (62.7)	30 (19.6)	27 (17.7)	153
Tamsulosin	76 (64.4)	24 (20.3)	18 (15.3)	118
Terazosin	9 (40.9)	6 (27.3)	7 (31.8)	22
Alfuzosin	11 (84.6)	0 (0)	2 (15.4)	13
Benzodiezepine	21 (56.8)	14 (37.8)	2 (5.4)	37
Finasteride	13 (81.3)	2 (12.5)	1 (6.2)	16

IFIS = intraoperative floppy iris syndrome.

Table 3.

Frequency of potential risk factors in subjects with and without intraoperative floopy iris syndrome

Risk Factors	IFIS		Non-IFIS		p-value^*
Risk Factors	N	No. Cases (%)	N	No. Cases (%)	p-value^*
α-adrenergic antagonist	178	153 (85.9)	803	116 (14.4)	<0.001
Tamsulosin	178	118 (66.3)	803	52 (6.5)	<0.001
Terazosin	178	22 (12.4)	803	34 (4.2)	<0.01
Alfuzosin	178	13 (7.3)	803	30 (3.7)	0.030
Benzodiazepine	178	37 (20.8)	803	59 (7.3)	<0.001
Finasteride	178	16 (9.0)	803	29 (3.6)	0.201
Sex, male	178	175 (98.3)	803	582 (72.4)	<0.001
Hypertension	178	90 (50.6)	803	459 (57.1)	0.182
Diabetes mellitus	178	58 (32.6)	803	251 (31.2)	0.605
Glaucoma	178	12 (6.7)	803	63 (7.8)	0.665

IFIS = intraoperative floppy iris syndrome.

^* Chi-squared test.

Table 4.

Potential risk factors associated with intraoperative floppy iris syndrome

	Odds ratio	Confidence interval	p-value^*
Tamsulosin	74.485	36.329-152.715	<0.001
Terazosin	19.283	8.881-41.871	<0.001
Alfuzosin	8.220	3.668-18.421	<0.001
Benzodiazepine	6.703	3.441-13.057	<0.001
Finasteride	0.798	0.325-1.963	0.624
Duration of α-adrenergic antagonist	1.090	1.004-1.182	0.040
Age	0.951	0.919-0.983	0.551
Sex, male	2.593	1.354-4.967	0.004
Hypertension	0.730	0.449-1.189	0.207
Diabetes mellitus	1.812	1.082-3.032	0.067
Glaucoma	1.142	0.456-2.859	0.776

^* Binominal logistic regression analysis.

Table 5.

Correlation analysis of IFIS grade and cumulative dosage of α-adrenergic antagonist

	Cumulative dosage (mg)	Kendall τ coefficient	p-value^*
Tamsulosin	5.16 ± 3.7	0.449	<0.001
Terazosin	4.69 ± 2.58	0.132	<0.001
Alfuzosin	4.31 ± 2.49	0.164	<0.001

Values are presented as mean ± SD.

^* Kendall’s tau-b analysis.

Table 6.

Differences of the IFIS grades between both eyes of the patients who underwent cataract surgery of both eyes and diagnosed with intraoperative floppy iris syndrome

	Δ Grade between both eyes	p-value^*
Total (n = 64)	0.45 ± 0.53	0.209^*
IFIS (+) in both eyes (n = 43)	0.16 ± 0.37	0.705^*
IFIS (+) in one eye (n = 21)	1.04 ± 0.21	0.221^*

Values are presented as mean ± SD.

ΔGrade = grade diffrerences between both eyes; IFIS = intraoperative floppy iris syndrome.

^* Wilcoxon signed rank test.

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