title: Factors associated with intraoperative floppy iris syndrome.
abstract: OBJECTIVE
  To identify factors associated with intraoperative floppy iris syndrome (IFIS) in patients undergoing routine phacoemulsification.
  
  
  METHODS
  Comparative case series.
  
  
  METHODS
  Analysis of 899 eyes of 660 patients undergoing routine cataract surgery.
  
  
  METHODS
  All routine cases of cataract extraction with posterior chamber intraocular lens implantation between September 1, 2005, and August 31, 2006, were documented. Pertinent patient information, including age, gender, race, medical history, and current medication use (including tamsulosin [Flomax, Boehringer-Ingelheim, Ingelheim, Germany], other alpha(1)-antagonists, angiotensin antagonists, anticholinergics, cholinergic agonists, muscle relaxants, nitric oxide donors, and saw palmetto), were collected at the time of surgery. A telephone survey was used to determine previous use of tamsulosin, other alpha(1)-antagonists, and saw palmetto. Cases were identified intraoperatively as IFIS or non-IFIS following the triad of criteria developed by Chang and Campbell.
  
  
  METHODS
  Presence of IFIS associated with medication use and medical history.
  
  
  RESULTS
  Analysis showed IFIS in 27 patients (4.1%) representing 33 eyes (3.7%). Tamsulosin use (P<0.001) and history of alpha(1)-antagonist use other than tamsulosin (P = 0.01) were shown to strongly correlate with IFIS in our study. Hypertension was noted to be a significant variable via multivariable generalized estimating equations analysis (P = 0.04) with a prevalence of 75.8% in patients with IFIS versus 56.4% in patients without IFIS. Saw palmetto showed a slight, but statistically insignificant, trend that current use or history of use may be associated with IFIS. There were no cases of posterior capsular rupture or vitreous loss.
  
  
  CONCLUSIONS
  Exposure to tamsulosin highly correlates with IFIS. Use of other alpha(1)-antagonists is also associated with IFIS. Several patients in our series were identified to have IFIS with no history of alpha(1)-antagonist use, indicating that other etiologic factors, or a combination of factors, can also elicit this response. Multivariable regression analysis shows no proven relationship between IFIS and individual use of angiotensin antagonists, anticholinergics, cholinergic agonists, muscle relaxants, nitric oxide donors, or saw palmetto, and diabetes or congestive heart failure.
authors.affiliation: Department of Ophthalmology, Storm Eye Institute, Charleston, South Carolina 29425, USA.
authors.forename: Kristiana D
authors.initials: KD
authors.lastname: Neff
authors.forename: Helga P
authors.initials: HP
authors.lastname: Sandoval
authors.forename: Luis E
authors.initials: LE
authors.lastname: Fernández de Castro
authors.forename: Amy S
authors.initials: AS
authors.lastname: Nowacki
authors.forename: David T
authors.initials: DT
authors.lastname: Vroman
authors.forename: Kerry D
authors.initials: KD
authors.lastname: Solomon
mesh_terms: D058668:Adrenergic alpha-1 Receptor Antagonists; D000317:Adrenergic alpha-Antagonists / Q000009:adverse effects*; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D007498:Iris / Q000187:drug effects*; D007499:Iris Diseases / Q000139:chemically induced*; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification; D012307:Risk Factors; D013449:Sulfonamides / Q000009:adverse effects*; D013577:Syndrome; D000077409:Tamsulosin
chemical_list: D058668:Adrenergic alpha-1 Receptor Antagonists; D000317:Adrenergic alpha-Antagonists; D013449:Sulfonamides; D000077409:Tamsulosin