title: Intraoperative floppy iris and prevalence of intraoperative complications: results from ophthalmic surgery outcomes database.
abstract: OBJECTIVE
  To estimate the prevalence of untoward events during cataract surgery with the use of pupillary expansion devices and intraoperative floppy iris (IFIS).
  
  
  METHODS
  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 χ(2) 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).
authors.affiliation: Veterans Affairs Saint Louis Healthcare System, St Louis, Missouri. Electronic address: david.vollman@va.gov.
authors.forename: David E
authors.initials: DE
authors.lastname: Vollman
authors.affiliation: Veterans Affairs Boston Healthcare System, Jamaica Plain, Massachusetts.
authors.forename: Luis A
authors.initials: LA
authors.lastname: Gonzalez-Gonzalez
authors.affiliation: Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee.
authors.forename: Amy
authors.initials: A
authors.lastname: Chomsky
authors.affiliation: Veterans Affairs Boston Healthcare System, Jamaica Plain, Massachusetts.
authors.forename: Mary K
authors.initials: MK
authors.lastname: Daly
authors.affiliation: Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Baze
authors.affiliation: Department of Defense/Veterans Affairs Vision Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland.
authors.forename: Mary
authors.initials: M
authors.lastname: Lawrence
mesh_terms: D058668:Adrenergic alpha-1 Receptor Antagonists / Q000008:administration & dosage / Q000009:adverse effects; D002387:Cataract Extraction / Q000706:statistics & numerical data*; D016208:Databases, Factual / Q000706:statistics & numerical data*; D005131:Eye Injuries / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007431:Intraoperative Complications / Q000139:chemically induced / Q000453:epidemiology*; D007499:Iris Diseases / Q000139:chemically induced / Q000453:epidemiology*; D007903:Lens Capsule, Crystalline / Q000293:injuries; D008297:Male; D016017:Odds Ratio; D015995:Prevalence; D011391:Prolapse; D012189:Retrospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*
chemical_list: D058668:Adrenergic alpha-1 Receptor Antagonists