Management of Intraocular Floppy Iris Syndrome (IFIS) in Cataract Surgery

Intraoperative floppy iris syndrome (IFIS) was first described in 2005 (Chang & Campbell 2005; Parssinen 2005). The fullblown syndrome comprises a triad of: 1) billowing of the iris stroma in response to normal irrigation currents, 2) the floppy iris tends to prolapse through the phaco and the side port incisions, and 3) a progressive pupillary constriction during the surgical procedure. Although IFIS may be multifactorial in etiology, systemic treatment with α-1a adrenergic receptor (AR) antagonists, and tamsulosin in particular, seems to play a pivotal role. The clinical presentation varies widely, from a mild form with a fluttering iris only, to the more severe case with the complete triad (Chang et al. 2007). The condition potentially increases the risk of intraoperative complications, such as iris trauma, zonular dehiscence, posterior capsule rupture, vitreous loss, as well as postoperative complications, including increased intraocular pressure and cystoid macular oedema. The prevalence of IFIS in cataract surgery varies among different countries, from 0.5 % to 2.0 % (Chang & Campbell 2005; Cheung et al. 2006; Chadha et al. 2008). The incidence of IFIS during cataract surgery in patients on tamsulosin medication varies from 43 – 100%. In contrast, the incidence of IFIS in patients taking one of the other α-1a AR antagonists, e.g. alfuzosin, is 10-15% (Blouin et al. 2007).