Intraoperative floppy iris syndrome in Indian population: A prospective study on incidence, risk factors, and impact on operative performance.

ABSTRACT

Purpose: The purpose of this study was to evaluate the incidence, risk factors, and impact of intraoperative fl oppy iris syndrome (IFIS) on surgical performance. Materials and Methods: Consecutive cataract surgeries from October 2010 to Feb 2011 (1003 eyes, 980 patients; 568 males, 412 females) were analyzed prospectively. Operating surgeon, masked about medication history, noted the intraoperative details. Cases were identifi ed as IFIS or non-IFIS. Multivariate analysis was performed to fi nd risk factors for IFIS. Results: Prevalence of tamsulosin use among men undergoing cataract surgery was 7.0% (41) with incidence of IFIS 4.78% (48). On multivariate analysis, hypertension (OR 3.2, 95% confi dence interval, 95% CI 1.39-6.57; P = 0.005), use of tamsulosin (OR 133.32, 95% CI 50.43-352.48; P < 0.0001), or alfuzosin (OR 9.36, 95% CI 2.34-37.50; P = 0.002) were the factors associated with IFIS. Among men taking tamsulosin (n = 41) and alfuzosin (n = 28), 68.3% and 16.6% developed IFIS, respectively. In subgroup analysis of men on tamsulosin, no factor added to the risk posed by tamsulosin. Seventeen of 944 eyes not exposed to any drug had IFIS (0.018%). On subgroup analysis, only risk factor for IFIS was hypertension (OR 4.67, 95% CI 1.63-13.35; P = 0.002). Of 48 IFIS eyes, the surgeon observed increased diffi culty in 57.1% (21) and additional measures were required in 9 eyes. Mean operative time was increased in IFIS eyes (11.68 ± 3.46 vs. 10.01 ± 0.22 min; P = 0.001). Surgical outcome was good in all cases. Conclusion: The prevalence of tamsulosin intake and IFIS incidence is higher in India. Current tamsulosin/alfuzosin use and hypertension are important risk factors. IFIS makes the surgery more diffi cult, signifi cantly prolongs the operative time, and predisposes for other intraoperative complications. However, with appropriate management, fi nal operative outcome is not aff ected.