MANAGING INTRAOPERATIVE FLOPPY IRIS SYNDROME WITH CANABRAVA PUPIL DILATOR

Summary: Intra-operative floppy iris syndrome (IFIS) also known as small pupil syndrome is a clinical entity that was first described by Chang and Campbell in 2005. IFIS is associated with those patients currently undergoing preoperative evaluations for cataracts that are on systemic therapy from the group of a1-adrenergic blockers, with a strong emphasis on Tamsulosin, the first drug of choice for treating benign prostatic hyperplasia(BPH). IFIS is characterized by a symptom triad of intraoperative signs during phacoemulsification surgery: flaccid stroma of the iris, prolapse of the iris through intraoperative incisions and progressive miosis. In these patients without adequate dilatation of the pupil, the syndrome itself leads to reduced visualization of the operative field and possible operative complications, the most common of which are posterior capsule rupture, iris transillumination characterized by bilateral acute iris dispersion, and pupillary sphincter tear. The goal of this study was to determine the need for Canabrava mechanical pupillary dilator during cataract surgery with phacoemulsification in patients at high risk for IFIS and who are on systemic therapy with Tamsulosin®, i.e. α1-adrenergic blockers due to benign hyperplasia of the prostate. During the study 40 patients were included and two groups were formed. The first control group consisted of 20 patients in whom Canabrava pupillary dilator was not used intraoperatively during phacoemulsification, and the second group consisted of the other 20 patients in whom Canabrava pupillary dilator was used intraoperatively in cataract surgery with phacoemulsification. All patients were monitored for: preoperative and postoperative best corrected visual acuity (BCVA), preoperative and intraoperative iris diameter, and the occurrence of intraoperative and postoperative complications.This study demonstrated that the Canabrava dilator, that allows the expansion of myotic pupils as well as the prevention of intraoperative and postoperative complications, is of great importance in patients with IFIS, ie during intraoperative use of Canabrava mechanical pupillary dilator we noticed a significant difference only in intraoperative and postoperative complications in patients who were included in the control and study groups.We achieved safe phacoemulsification surgery despite the fact that the patients were on systemic therapy from the group of α1-adrenergic blockers, namely Tamsulosin®