title: Intraoperative floppy iris syndrome in Indian population: a prospective study on incidence, risk factors, and impact on operative performance.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the incidence, risk factors, and impact of intraoperative floppy iris syndrome (IFIS) on surgical performance.
  
  
  METHODS
  Consecutive cataract surgeries from October 2010 to Feb 2011 (1003 eyes, 980 patients; 568 males, 412 females) were analyzed prospectively. Operating surgeon, masked about medication history, noted the intraoperative details. Cases were identified as IFIS or non-IFIS. Multivariate analysis was performed to find risk factors for IFIS.
  
  
  RESULTS
  Prevalence of tamsulosin use among men undergoing cataract surgery was 7.0% (41) with incidence of IFIS 4.78% (48). On multivariate analysis, hypertension (OR: 3.2, 95% confidence interval, 95% CI: 1.39-6.57; P = 0.005), use of tamsulosin (OR: 133.32, 95% CI: 50.43-352.48; P < 0.0001), or alfuzosin (OR: 9.36, 95% CI: 2.34-37.50; P = 0.002) were the factors associated with IFIS. Among men taking tamsulosin (n = 41) and alfuzosin (n = 28), 68.3% and 16.6% developed IFIS, respectively. In subgroup analysis of men on tamsulosin, no factor added to the risk posed by tamsulosin. Seventeen of 944 eyes not exposed to any drug had IFIS (0.018%). On subgroup analysis, only risk factor for IFIS was hypertension (OR: 4.67, 95% CI: 1.63-13.35; P = 0.002). Of 48 IFIS eyes, the surgeon observed increased difficulty in 57.1% (21) and additional measures were required in 9 eyes. Mean operative time was increased in IFIS eyes (11.68 ± 3.46 vs. 10.01 ± 0.22 min; P = 0.001). Surgical outcome was good in all cases.
  
  
  CONCLUSIONS
  The prevalence of tamsulosin intake and IFIS incidence is higher in India. Current tamsulosin/alfuzosin use and hypertension are important risk factors. IFIS makes the surgery more difficult, significantly prolongs the operative time, and predisposes for other intraoperative complications. However, with appropriate management, final operative outcome is not affected.
authors.forename: Shilpa
authors.initials: S
authors.lastname: Goyal
authors.forename: Deepansh
authors.initials: D
authors.lastname: Dalela
authors.affiliation: Department of Urology, King George Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Neeraj Kumar
authors.initials: NK
authors.lastname: Goyal
authors.forename: Shobhit
authors.initials: S
authors.lastname: Chawla
authors.forename: Rajat
authors.initials: R
authors.lastname: Dhesi
authors.forename: Bela
authors.initials: B
authors.lastname: Kamboj
authors.forename: Abha
authors.initials: A
authors.lastname: Dalela
mesh_terms: D058668:Adrenergic alpha-1 Receptor Antagonists / Q000009:adverse effects; D005260:Female; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007431:Intraoperative Complications / Q000139:chemically induced / Q000453:epidemiology*; D007499:Iris Diseases / Q000139:chemically induced / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification / Q000009:adverse effects*; D011446:Prospective Studies; D012307:Risk Factors; D013449:Sulfonamides / Q000009:adverse effects*; D000077409:Tamsulosin
chemical_list: D058668:Adrenergic alpha-1 Receptor Antagonists; D013449:Sulfonamides; D000077409:Tamsulosin