Eyeworld

N APRIL 2019 | EYEWORLD | 43 The male cases were better controlled with careful incision location and construction and use of less aggressive, low-flow phaco fluidic param- eters, the researchers wrote. In contrast, female cases required use of more than one ophthalmic viscosurgical device, intracameral use of epineph- rine, longer operating times, and anterior vitrecto- my for posterior capsule rupture. "Male patients were also better briefed before surgery on the possible complications, and their anticipations were handled more efficiently compared with female IFIS patients," they wrote. There also were some differences in CDVA with glasses at 2 months in the female IFIS cases compared with females. Specifically, the CDVA was lower compared with non-IFIS cases. "The final CDVA (with spectacles) was found to be influenced by the IFIS severity grade only in females," they wrote. A few surprises Dr. Tzamalis and his co-researchers were sur- prised by the findings. "The intraoperative complications rate in females was much higher, leading to a poorer final visual outcome," he said. Despite the prevalence of experienced surgeons working with the cases, there was a markedly higher percentage of posterior capsule rupture, the authors noted. Michael Greenwood, MD, was initially surprised by the results, until he thought about it a little more. "In hindsight, when you're not expecting IFIS to come into play, it puts you more at risk for complications. It makes sense in the bigger picture," he said. Surgeons should remain vigilant about IFIS risk in males and females, both to avoid negative consequences if they are not managed properly and because a growing number of drugs seem to be associated with IFIS risk, surgeons said. Dr. Tzamalis and co-researchers will publish results soon from a large multivariate regression analysis that analyzes systemic medications and their risk factors for the appearance of IFIS in women. Pearls to help lower the risk of IFIS Consider IFIS risk in all patients "Thorough current and previous medication use documentation, preoperative recognition of those at risk for developing IFIS, and the surgeon's awareness in advance are all crucial in safely managing this condition," Dr. Tzamalis said. 1. 2. 3. Think beyond tamsulosin Although tamsulosin is the drug associated most closely with IFIS, there appears to be a growing list of other medications that can raise the risk, Dr. Greenwood said. Other medica- tions associated with IFIS include finasteride, anti-psychotic agents, donepezil, duloxetine, labetalol, and herbal remedies like saw palmetto, according to the study from Dr. Tzamalis. It's also important to keep the risk in mind because even a one-time use could increase the chance of IFIS occurring, Dr. Greenwood cautioned. Use surgical tricks and techniques to avoid or manage IFIS "Proper wound construction can help with other complications of IFIS, like having iris prolapse," Dr. Greenwood said. There also is some evidence that pretreating with a nonste- roidal anti-inflammatory drug before cataract surgery can help stiffen the iris and lessen the effect of IFIS. Use of Omidria (phenylephrine/ ketorolac, Omeros) intracamerally during cata- ract surgery can also lessen the effect, Dr. Greenwood said. Reference 1. Tzamalis A, et al. The role of sex in intraoperative floppy-iris syndrome. J Cataract Refract Surg. 2019;45:41–47. Financial interests Greenwood: None Tzamalis: None

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