Original article
Intraoperative Floppy Iris and Prevalence of Intraoperative Complications: Results From Ophthalmic Surgery Outcomes Database

https://doi.org/10.1016/j.ajo.2014.02.052Get rights and content

Purpose

To estimate the prevalence of untoward events during cataract surgery with the use of pupillary expansion devices and intraoperative floppy iris (IFIS).

Design

Retrospective analysis of 4923 cataract surgery cases from the Veterans Affairs Ophthalmic Surgical Outcomes Data Project.

Methods

Outcomes from 5 Veterans Affairs medical centers were analyzed, including use of alpha-blockers (both selective and nonselective), IFIS, intraoperative iris trauma, intraoperative iris prolapse, posterior capsular tear, anterior capsule tear, intraoperative vitreous prolapse, and use of pupillary expansion devices. P values were calculated using the χ2 test.

Results

A total of 1254 patients (25.5%) took alpha-blockers preoperatively (selective, 587; nonselective, 627; both, 40). Of these 1254 patients, 428 patients (34.1%) had documented IFIS. However, 75.2% of patients with IFIS (428/569) had taken alpha-blockers preoperatively (P < .00001). A total of 430 patients (8.7%) had a pupillary expansion device used during their cataract surgery, of which 186 patients (43.4%) had IFIS (P < .0001). Eighty-six patients with IFIS had at least 1 intraoperative complication and 39 patients with IFIS had more than 1 intraoperative complication (P < .001).

Conclusions

The use of either selective or nonselective alpha-antagonists preoperatively demonstrated a significant risk of IFIS. Nonselective alpha-antagonists caused IFIS at a higher prevalence than previously reported. This study did demonstrate statistically significant increased odds of surgical complications in patients with IFIS vs those without IFIS in all groups (those taking selective and nonselective alpha-antagonists and also those not taking medications).

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

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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.

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