title: Sub-Tenon injection of 2% lidocaine prevents intra-operative floppy iris syndrome (IFIS) in male patients taking oral α-adrenergic antagonists.
abstract: OBJECTIVE
  To compare 2% sub-Tenon and 1% intra-cameral lidocaine for cataract surgery in relation to the incidence and severity of IFIS. Prospective randomized clinical study.
  
  
  METHODS
  From 81 eligible, we included 71 men aged from 59 to 90 years (mean 76.5 ± 6.8) undergoing routine cataract surgery and taking oral α-adrenergic antagonists, for urological reasons, for more than 1 year. Following randomization 34 men, aged from 62 to 90 years (mean 77.4 ± 8.1) received sub-Tenon injection of 2.5 ml of 2% lidocaine and the remaining 37 men aged from 59 to 89 years (mean 75.2 ± 7.2) received 1% preservative free intra-cameral lidocaine. Outcome measures were the incidence of IFIS, severity of intra-operative pupillary constriction and iris prolapse.
  
  
  RESULTS
  Intra-operative floppy iris syndrome (IFIS) was noted in 3 of 34 patients (8.8%) receiving sub-Tenon lidocaine and in 18 of 37 patients (48.6%) receiving intra-cameral lidocaine (p = 0.00). Severe IFIS was observed only in 3 of 37 patients (8.1%) receiving intra-cameral lidocaine. Pupil diameter at the end of surgery was 4.37 ± 1.07 mm in the sub-Tenon lidocaine group and 4.02 ± 1.06 mm in the intra-cameral lidocaine group (p = 0.00). Iris prolapse was noted in two cases in the sub-Tenon lidocaine group and in 10 cases in the intra-cameral lidocaine group (p = 0.00). Twenty-five patients were receiving tamsulosin. The incidence of IFIS in tamsulosin subgroup was 76.9% (10 of 13 patients) in the intra-cameral lidocaine group and 16.6% (2 of 12 patients) in the sub-Tenon lidocaine group (p = 0.00).
  
  
  CONCLUSIONS
  Sub-Tenon lidocaine reduces significantly the incidence of IFIS in patients taking oral α-adrenergic inhibitors as compared with intra-cameral lidocaine.
authors.affiliation: Department of Ophthalmology, Medical University of Lodz, Lodz, PolandDepartment of Ophthalmology, Hospital of the Ministry of Internal Affairs and Administration, Lodz, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Klysik
authors.forename: Dorota
authors.initials: D
authors.lastname: Korzycka
mesh_terms: D058668:Adrenergic alpha-1 Receptor Antagonists / Q000009:adverse effects*; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000627:therapeutic use; D006801:Humans; D056965:Injections, Intraocular; D007431:Intraoperative Complications; D007499:Iris Diseases / Q000139:chemically induced / Q000175:diagnosis / Q000517:prevention & control*; D019654:Lens Implantation, Intraocular; D008012:Lidocaine / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009184:Mydriatics / Q000627:therapeutic use*; D018918:Phacoemulsification; D011391:Prolapse; D011446:Prospective Studies; D011470:Prostatic Hyperplasia / Q000188:drug therapy; D058475:Tenon Capsule / Q000187:drug effects*
chemical_list: D058668:Adrenergic alpha-1 Receptor Antagonists; D000779:Anesthetics, Local; D009184:Mydriatics; D008012:Lidocaine
keywords: cataract surgery; intra-operative floppy iris syndrome (IFIS); iris prolapse; postoperative complications; pupillary diameter; sub-Tenon’s anaesthesia