Original articleIntraoperative Floppy Iris and Prevalence of Intraoperative Complications: Results From Ophthalmic Surgery Outcomes Database
Section snippets
Methods
For this multicenter, retrospective analysis, internal review board (IRB) approval was obtained at all 5 Veterans Health Administration pilot sites. The data were collected and analyzed in a HIPAA-compliant fashion. Informed consent was waived by the IRB because it would be impossible to obtain consent from patients in a masked database since this was a retrospective analysis of a previously collected dataset used for internal quality assurance in the Veterans Health Administration. The initial
Results
From April 1, 2009 to February 15, 2012, 4923 eyes of 3809 patients were included in the Ophthalmic Surgery Outcomes Database pilot project. A total of 1254 patients (25.5%, 1254/4923) took alpha-antagonists preoperatively. Of these patients, 587 patients (46.8%, 587/1254) took selective alpha-antagonists, 627 patients (50.0%, 627/1254) took nonselective alpha-antagonists, and 40 patients (3.2%, 40/1254) took both (Figure). A total of 569 patients (11.5%, 569/4923) had documented cases of IFIS.
Discussion
Repeated studies have shown that selective alpha1-antagonists, specifically tamsulosin, are associated with higher rates of IFIS.3, 4, 5, 6, 7 The agreement on the association between nonselective alpha-antagonists and IFIS has been mixed.3, 6 Our study demonstrated again a statistically significant relationship between preoperative alpha-antagonist use and IFIS, in line with prior studies.3, 4, 5 However, our study did show a much higher rate of IFIS being caused by nonselective
David E. Vollman, MD, MBA is an assistant professor and assistant residency program director in the department of ophthalmology and visual sciences at the Washington University School of Medicine as well as a staff ophthalmologist at the St. Louis VA Medical Center. After completing an MD/MBA dual-degree program at the Ohio State University College of Medicine, he completed his ophthalmology residency at the Washington University/Barnes-Jewish Hospital/St. Louis Children's Hospital Consortium
References (8)
- et al.
Prospective multicenter evaluation of cataract surgery in patients taking tamsulosin (Flomax)
Ophthalmology
(2007) - et al.
Factors associated with intraoperative floppy iris syndrome
Ophthalmology
(2009) - et al.
Intraoperative floppy-iris syndrome associated with alpha1-adrenoreceptors: comparison of tamsulosin and alfuzosin
J Cataract Refract Surg
(2007) Use of Malyugin pupil expansion device for intraoperative floppy-iris syndrome: results in 30 consecutive cases
J Cataract Refract Surg
(2008)
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2015, Journal of Cataract and Refractive SurgeryCitation Excerpt :Outcomes vary from increased surgery duration or need for an early second procedure137 to complications such as iris atrophy, posterior capsule rupture, and zonular disinsertion.132 The risk for surgical complications is significantly increased in all groups with IFIS.142 The best strategy would be to prevent IFIS by avoiding the use of tamsulosin and α-antagonists in patients who need cataract surgery.132
David E. Vollman, MD, MBA is an assistant professor and assistant residency program director in the department of ophthalmology and visual sciences at the Washington University School of Medicine as well as a staff ophthalmologist at the St. Louis VA Medical Center. After completing an MD/MBA dual-degree program at the Ohio State University College of Medicine, he completed his ophthalmology residency at the Washington University/Barnes-Jewish Hospital/St. Louis Children's Hospital Consortium Program.