IFIS Intraoperative Floppy-Iris Syndrome by Dr. Fritz Allen

1. IFIS – Intraoperative Floppy-Iris Syndrome Fritz Allen 10-2010

3. ASCRS White Paper JCRS 12/08

13. The Effect of the α 1 -Adrenergic Receptor Antagonist Tamsulosin (Flomax) on Iris Dilator Muscle Anatomy Ricardo Santaella, MD, John Destafeno, MD, Sara Miller, PhD, Sandra Stinnett, DrPH, Alan Proia, MD, Terry Kim, MD Albert Eye Research Institute Duke University Medical Center Durham, North Carolina

14. Control Subject Tamsulosin Subject Light Microscopy Morphometric Results Representative sample photomicrographs * Indicates iris dilator smooth muscle. (H&E) Mean (micrometers) Tamsulosin group n=26 Control Group n=26 P-Value* Iris Dilator Muscle Thickness 6.62 (SD=2.22) 8.20 (SD=1.77) 0.004 Iris Stromal Thickness 275.98 (SD=68.17) 274.65 (SD=57.96) 0.925

24. epi hooks H 5 atropine Multiple strategies Rings Other Favorite initial strategy for IFIS

25. 18% more difficult, same risk 65% more difficult, >risk 5% “ No different” Surgical difficulty with tamsulosin 13% very difficult, >risk 95% “ More Difficult” 5% 77% “ Greater Risk”

26. 23% >PC Rupture 52% > iris trauma 30%

29. Routine referral pre-tamsulosin? 41% “NO” 38% “ IF HX OR CATARACT” 21% “ ROUTINELY” VA Other α -blockers 58% “NO” 11% “ROUTINELY” 31% “IF HX CAT”

30. More education for prescribing MD? 91% Agree 3% Disagree