Pre-Cataract Surgery Regimen Significantly Decreases Floppy Iris Syndrome

Process of cataract surgery in modern clinic
Atropine 1% and NSAIDs twice a day for 3 days prior to the operation kept more irises intact, a report shows.

This article is part of Ophthalmology Advisor’s conference coverage from the 2021 meeting of American Society of Cataract and Refractive Surgery (ASCRS), held in Las Vegas from July 23 to 27, 2021. The team at Ophthalmology Advisor will be reporting on a variety of research presented by the cataract and refractive surgery experts at ASCRS. Check back for more from the ASCRS 2021 Meeting.


Rates of intraoperative floppy iris syndrome (IFIS) were significantly decreased among patients pretreated with atropine 1% and non-steroidal anti-inflammatory drugs (NSAIDs) prior to cataract surgery in a study presented during the 2021 American Society of Cataract and Refractive Surgery (ASCRS) meeting held July 23-27, in Las Vegas.

Researchers retrospectively reviewed the cases of 207 patients with a history of alpha-antagonist use who underwent cataract surgery by phacoemulsification at 2 centers in Israel between 2019 and 2020. The 2 hospitals differed for their IFIS prevention policies. The Meir Medical Center had no policy of pretreatment to prevent IFIS and Shamir Medical Center gave atropine 1% QD and NSAIDs TID for 3 days prior to surgery for patients who were at high risk for IFIS.

The patient population comprised 82.1% men (mean age 74.9±7.8 years). Patients had a history of using the alpha-antagonists tamsulosin (31.4%), doxazosin (26.1%), tamsulosin and dutasteride dual therapy (23.2%), alfuzosin (15.9%), and unspecified alpha-antagonists (4.8%).

A total of 106 patients had surgery at the hospital with the pretreatment policy, of whom 86.8% (n=92) received atropine 1% and NSAIDs prior to surgery.

The rate of IFIS at the center that did not pretreat at-risk patients was 29.7% compared with 15.1% at the center with the IFIS prevention policy (P =.012).

Stratified by pretreatment status, the IFIS rate was significantly lower among patients who received the atropine 1% and NSAID therapy (12.0% vs 30.4%; P =.001).

Receiving the pretreatment was associated with decreased risk for IFIS after adjusting for age and gender (adjusted odds ratio [aOR], 0.329; 95% CI, 0.150-0.720; P =.005).

These data indicated a policy of pretreating patients with a history of alpha-antagonist use with atropine 1% and NSAIDs for 3 days prior to cataract surgery by phacoemulsification significantly reduced IFIS rates.

Disclosure: An author declared affiliations with industry. Please refer to the original article for a full list of disclosures.

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Safir M, Hecht I, Vardi M, et al. Preoperative Atropine and Non-Steroidal Anti-Inflammatory Drugs for the Prevention of Intraoperative Floppy Iris Syndrome. Poster presented at: 2021 ASCRS Annual Meeting; July 2021; Las Vegas, NV. Abstract 75520.