Intracameral phenylephrine may aid cataract surgery in patients with floppy iris syndrome

A staged approach to management of intraoperative floppy iris syndrome may help to avoid complications during cataract surgery in patients taking tamsulosin, a study by British surgeons suggests. Preoperative treatment with phenylephrine and the addition of intracameral phenylephrine when necessary effectively prevented serious complications in a series of patients, the authors reported.

Sridhar Manvikar, FRCOphth, and David Allen, FRCS, FRCOphth, of Sunderland Eye Infirmary in Sunderland, England, evaluated the efficacy of this staged approach in 32 eyes of 20 patients undergoing cataract surgery. All patients had been using Flomax (tamsulosin, Boehringer-Ingelheim) for at least 6 months before surgery, according to the study.

Based on the study results, the researchers proposed this "interim algorithm" for managing IFIS patients:

53% of patients will have large pupils
half of these will constrict during surgery; phenylephrine will redilate these pupils and either prevent or reduce re-constriction.
38% of patients will have a mid-dilated pupil; phenylephrine will not enlarge most of these pupils, but it will either prevent further constriction or will moderately redilate the pupil.
Roughly 9% of patients will have small pupils, which experienced surgeons can manage using intracameral phenylephrine without using hooks or pupil expanders.

The study is published in the October issue of the Journal of Cataract & Refractive Surgery.