Floppy iris syndrome prediction in patients with age-related cataract and benign prostatic hyperplasia

Abstract

Purpose. To determine prognostic criteria of clinically significant intra-operative floppy iris syndrome (IFIS) in patients receiving α1-blockers.Material and methods. Using the optical coherence tomography of the anterior segment of the eye (AS-OCT) we examined 60 patients (60 eyes) with cataract and benign prostatic hyperplasia treated with tamsulosin or silodosin, and 33 men with cataract (33 eyes), who had no indication for α1-blockers treatment. All patients underwent phacoemulsification of the age-related cataract. Possible prognostic parameters of clinically significant (moderate and severe) IFIS development were evaluated using ROC-analysis.Results. The clinically significant IFIS developed in 14 patients treated with α1-blockers. According to the AS-OCT these patients had more pronounced narrowing of the pupil and iris thinning in the region of the pupil dilator on the temporal side. Dilated pupil diameter and the duration of α1-blockers treatment were the most informative predictors of clinically significant IFIS. With the threshold values corresponding to the 95% specificity (≤4.5mm and >45 months), these parameters provided the clinically significant IFIS prediction with sensitivity of 85.4% and 71.4%, respectively. The following simple predictive rule was suggested. Development of clinically significant IFIS could be expected if at least one of the following two conditions is met: 1.The diameter of the dilated pupil is not more than 4.6mm; 2. Duration of α1-blockers treatment is over 3.5 year s.Conclusion. The proposed prognostic criteria and the simple prognostic rule provide the most complete and timely identification of patients with the clinically significant IFIS, promoting its proper prevention.

Keywords

• benign prostatic hyperplasia
• α1-blockers
• cataract
• intra-operative floppy iris syndrome
• optical coherence tomography of the anterior segment
• prediction
• roc-analysis