title: Modified corneal incisions in intraoperative floppy iris syndrome (IFIS)-prone patients.
abstract: BACKGROUND
  We aimed to report a simple technique that involves modified anterior (to the limbus) elongated corneal incisions in order to reduce the incidence and severity of intraoperative floppy iris syndrome (IFIS) and related complications.
  
  
  METHODS
  This was a retrospective study of phacoemulsification cataract surgeries performed by a single surgeon on patients receiving tamsulosin or alfuzosin between 1 January 2009 and 31 July 2012 at Meir Medical Center, Kfar-Sava, Israel. We recorded preoperative gender, age, α-antagonist medication, coexisting pseudoexfoliation (PXF), and intraoperative use of ophthalmic viscosurgical devices (OVDs), pupil size, complications, IFIS grading and the need for additional operative strategies to manage IFIS. Elongated corneal incisions were performed approximately 1 mm anterior to the limbus.
  
  
  RESULTS
  Ninety-three eyes of 81 men were included. Mean age was 76.5 years (range 55 to 96 years). Forty-seven eyes (40 patients) had documented use of alfuzosin and 45 eyes (40 patients) of tamsulosin. One patient received both. The overall rate of IFIS was 22.6 % (n = 21). Eyes of patients who were treated with alfuzosin had a milder grading (p < 0.001) and an overall lower percentage of IFIS compared to tamsulosin (4.26 % versus 42.22 % respectively, p < 0.001). No additional strategies were used to manage IFIS during surgery. No intraoperative complications occurred.
  
  
  CONCLUSIONS
  Anterior elongated incisions are simple and efficient in preventing IFIS, exempting the surgeon from the use of additional expensive devices or materials in most cases. They do not limit the surgeon to one strategy, and therefore, if necessary, another may be applied at any given time.
authors.affiliation: Department of Ophthalmology, Meir Medical Center, 59 Tchernichovsky St., Kfar Sava, 44410, Israel.
authors.forename: Sharon
authors.initials: S
authors.lastname: Armarnik
authors.affiliation: Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Mimouni
authors.affiliation: Department of Ophthalmology, Meir Medical Center, 59 Tchernichovsky St., Kfar Sava, 44410, Israel.
authors.forename: Eli
authors.initials: E
authors.lastname: Rosen
authors.affiliation: Department of Ophthalmology, Meir Medical Center, 59 Tchernichovsky St., Kfar Sava, 44410, Israel.
authors.forename: Ehud I
authors.initials: EI
authors.lastname: Assia
authors.affiliation: Department of Ophthalmology, Meir Medical Center, 59 Tchernichovsky St., Kfar Sava, 44410, Israel. fsegev@netvision.net.il.
authors.forename: Fani
authors.initials: F
authors.lastname: Segev
mesh_terms: D058668:Adrenergic alpha-1 Receptor Antagonists / Q000009:adverse effects*; D000368:Aged; D000369:Aged, 80 and over; D003315:Cornea / Q000601:surgery*; D004338:Drug Combinations; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000517:prevention & control*; D007499:Iris Diseases / Q000139:chemically induced / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification / Q000379:methods*; D011470:Prostatic Hyperplasia / Q000188:drug therapy; D011799:Quinazolines / Q000009:adverse effects; D012189:Retrospective Studies; D013449:Sulfonamides / Q000009:adverse effects; D000077409:Tamsulosin
chemical_list: D058668:Adrenergic alpha-1 Receptor Antagonists; D004338:Drug Combinations; D011799:Quinazolines; D013449:Sulfonamides; C047638:alfuzosin; D000077409:Tamsulosin
keywords: Alfuzosin; Anterior; Cataract; Elongated; IFIS; Incisions; Tamsulosin