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Preop identification of alpha-blockers helps prevent IFIS complications

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HONG KONG — When surgeons identify cataract surgery patients on alpha-blocking medications, they can take steps to avoid intraoperative floppy iris syndrome complications.

Tetsuro Oshika

"The IFIS triad of complications are billowing of the iris tissue, iris prolapsed into any incisions or phaco tip, and progressive intraoperative miosis," Tetsuro Oshika, MD, of the University of Tsukuba in Japan, said here at the World Ophthalmology Congress.

The drugs available in Japan, where there is a 1.1% rate of IFIS, are tamsulosin, naftopidil and silodosin, all of which have selective affinity of alpha-1A and alpha-1L receptor subtypes, according to Dr. Oshika.

Dr. Oshika uses an anti-IFIS strategy consisting of epinephrine with acidity lowered by the use of balanced salt solution. Employing this strategy, Dr. Oshika lowered his incidence of IFIS complications from 31 before using the regimen to 18 afterward, beginning in November 2005.

Posterior capsule rupture went from 6.5% of his cases before the epinephrine treatment to none after. Iris damage went from 13% before to 5.6% after.