Microincisional Cataract Surgery Advantage in Intraoperative Floppy-Iris Syndrome Cases
Narrative Responses:
Purpose
To examine the outcomes and safety record using the Stellaris phacoemulsification system (Bausch & Lomb) and MICS (microincisional cataract surgery) platform in IFIS (intraoperative floppy iris syndrome) cases.
Methods
A retrospective review of 40 eyes that underwent uncomplicated planned phacoemulsification with intraocular lens implantation under topical and intracameral anesthesia and intravenous sedation with low dose 10 mg ketamine. The microincision size in all cases ranged from 1.8-2.0 mm using the Stellaris phacoemulsification system. An alpha-1 adrenergic antagonist such as tamsulosin or silodosin was used in every patient preoperatively for prostate treatment purposes, increasing the risk of IFIS and other serious adverse events associated with IFIS intraoperatively. No iris pupillary expansion devices such as iris retractors or rings were allowed in this study group.
Results
Statistical analysis of all eyes revealed outcomes and a safety record approaching that of non alpha-1 adrenergic antagonist users undergoing cataract surgery. Specifically, the reported incidence of of posterior capsule rupture and/or vitreous loss was 0% and iris trauma was 3% in this study group compared favorably to published reports of 23% and 52%, respectively, in IFIS cases.
Conclusion
The MICS advantage with the Stellaris phacoemulsification system allowed for statistically significant reduction in IFIS-related complications previously published. Despite FDA labelling of all alpha-1 adrenergic antagonists for increased IFIS risk during routine cataract surgery, MICS can now return to status quo with improved intraoperative efficiency, safety, and visual outcomes.