Eyeworld

N EWS 42 | EYEWORLD | APRIL 2019 by Vanessa Caceres EyeWorld Contributing Writer RESEARCH HIGHLIGHT Contact information Greenwood: Michael.greenwood @vancethompsonvision.com Tzamalis: argyriostzamalis @yahoo.com was a risk factor in male patients but not females. Ocular risk factors typically associated with IFIS, such as glaucoma, ocular hypertension, and diabetic retinopathy, did not appear to influence the incidence of IFIS. Most male and female IFIS cases were operated on by senior surgeons. The only factor that appeared to influence IFIS was the use of alpha-1 receptor antagonists in males. The incidence of posterior capsule rupture increased significantly by the appearance of IFIS (P<.0001). Severity grades were not significant- ly different between males (mean, 1.96) versus females (2.11). However, there were some differences when IFIS occurred in females. "In a between-sex com- parison of IFIS patients, the posterior capsule rupture rate was significantly higher in female pa- tients than male patients," the researchers wrote. All female IFIS cases had vitreous loss with posterior capsule ruptures, while the respective proportion in males was 78% among the posteri- or capsule rupture cases. "The female sex was found to be a statistically significant risk factor for posterior capsule rupture, vitreous loss, and nucleus drop in cases in which IFIS occurred," according to the researchers. Y ou may be ever-vigilant about intraop- erative floppy iris syndrome (IFIS) in male cataract patients of a certain age, but what about female patients? A newly published study 1 found that although IFIS was less common in females, it was associated with more intraoperative complications and worse visual outcomes. Led by Argyrios Tzamalis, MD, researchers focused on male and female differences related to IFIS in cataract surgery patients. They wanted to address this because little has been published about IFIS differences in males versus females. Their comparative, retrospective case control study included 3,811 eyes from 3,213 patients. All IFIS cases were classified as grade 0 (no progressive miosis, iris billowing, or iris prolapse observed), grade 1 (one of the three IFIS signs), grade 2 (two of the three signs), and grade 3 (all three IFIS signs). Risk factors related to IFIS were also noted, including pseudoexfoliation, glauco- ma, ocular hypertension, and diabetic retinopathy. All patients in the study had standardized preop dilation with tropicamide 0.5%, phenyl- ephrine hydrochloride 2.5%, and cyclopentolate 1% drops. Topical anesthesia was performed with proparacaine hydrochloride 0.5% and intracam- eral anesthesia with an ophthalmic viscosurgical device. Cataract surgery was done with a 2.4 mm clear corneal incision and two side ports. Sur- geons evaluated the final corrected distance visual acuity (CDVA) at a 2-month follow-up. Among all patients, 50.8% were female. The mean patient age was 72.3 years. Results The overall IFIS incidence in the study was 3.2%, which is in line with previous studies that have found a rate between 0 and 3.7%, according to the researchers. The incidence of IFIS was 5.17% in male patients (97 of 1,874 eyes) compared with 1.29% of female patients (25 of 1,937 eyes). In- traoperative floppy iris syndrome was significantly higher in male versus female patients (P<.0001). Researchers did not find a significant age difference when comparing IFIS in males versus females. The use of alpha-1 receptor blockers Study shows IFIS cases more severe in females Iris prolapse during hydrodissection in a patient taking tamsulosin Source: David F. Chang, MD About the doctors Michael Greenwood, MD Vance Thompson Vision Fargo, South Dakota Argyrios Tzamalis, MD Aristotle University of Thessaloniki Papageorgiou General Hospital Thessaloniki, Greece

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