title: Pediatric intraoperative floppy-iris syndrome.
abstract: We report an unusual intraoperative finding in the case of a 4-month-old infant with bilateral congenital cataracts removed within a 1-week period. Surgery in the right eye was uneventful. During removal of the cataract in the left eye, signs of the intraoperative floppy-iris syndrome (IFIS) were observed; ie, iris floppiness, iris prolapse to the incisions, and progressive miosis. The surgical technique was identical in both eyes except that epinephrine was added to the irrigating solution in the right eye but inadvertently omitted in the left-eye surgery. Use of intracameral epinephrine has been documented to prevent IFIS in adult eyes at risk for developing the syndrome. Our case highlights the importance of epinephrine in the irrigating solution in pediatric cataract surgery.
authors.affiliation: Miles Center for Pediatric Ophthalmology, Storm Eye Institute, Department of Ophthalmology, Medical University of South Carolina, Charleston, South Carolina 29425-5536, USA. wilsonme@musc.edu
authors.forename: M Edward
authors.initials: ME
authors.lastname: Wilson
authors.forename: Rupal H
authors.initials: RH
authors.lastname: Trivedi
authors.forename: Susannah
authors.initials: S
authors.lastname: Mistr
mesh_terms: D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage; D002386:Cataract / Q000151:congenital; D002387:Cataract Extraction; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D005317:Fetal Growth Retardation; D006801:Humans; D007223:Infant; D007431:Intraoperative Complications; D007499:Iris Diseases / Q000209:etiology* / Q000517:prevention & control; D019654:Lens Implantation, Intraocular; D009883:Ophthalmic Solutions; D011391:Prolapse; D013577:Syndrome; D007507:Therapeutic Irrigation
chemical_list: D000316:Adrenergic alpha-Agonists; D009883:Ophthalmic Solutions; D004837:Epinephrine