![]() Ocular inserts represent an alternative to eye drops (ie, Mydriasert Thea). Preoperative use of nonsteroidal antiinflammatory drugs (NSAIDs) such as nepafenac0.1%, bromfenac 0.09%, and ketorolac 0.4% also contributes to the maintenance of dilation by blocking the miotic effect of prostaglandins released during cataract surgery. Presurgical mydriasis is usually achieved by a combination of topical drops or topical gel formulations, including tropicamide 1%, cyclopentolate 1%, and phenylephrine 2.5%. 4 It has been shown that the use of atropine 1% twice a day for 2 to 3 days prior to surgery can prevent IFIS in patients taking tamsulosin. 3 There is a 2.3 times greater risk of complications during phacoemulsification in patients taking tamsulosin. ![]() This syndrome has been linked to use of the α-1A-adrenergic receptor antagonist, tamsulosin. IFIS was first described by Chang and Campbell in 2005 with the clinical triad of a flaccid, billowing iris a tendency for iris prolapse through wounds and progressive miosis. Finally, in intraoperative floppy iris syndrome (IFIS), miosis may be due to dilator muscle atrophy from chronic α-1A sympathetic blockade at the receptor site. Uveitis, trauma, angle-closure attacks, and prior intraocular surgery can cause iris synechiae to the anterior capsule and miosis. In pseudoexfoliation syndrome, iris dilator muscle atrophy or sphincter muscle fibrosis represent the two main mechanisms of poor dilation. Patients with diabetes may experience poor dilation because of autonomic dysfunction or rubeosis iridis. The long-term use of topical miotics such as pilocarpine in glaucoma patients can cause fibrosis of the iris sphincter and poor dilation. ![]() Most cataract patients are older, and aging can cause iris atrophy and a miotic pupil. Insufficient pupillary dilation can pose surgical challenges to ophthalmologists such as an obstructed view, reduced red reflex, difficult capsulorhexis, iris prolapse from wounds, risk of bleeding, increased inflammation from iris trauma, and increased risk of posterior capsular rupture and vitreous loss. Investing in New Devices for Cataract Surgeryĭuring cataract surgery, the pupil must be sufficiently dilated to provide adequate surgical access to the cataract. What to Do When Customers Criticize You Online The Impact of Mergers and Acquisitions on Industry’s Relationship With Ophthalmologists ![]() Sidebar: Are Changes to the CE Marking Process Imminent? Pharmacologic Approaches to the Small Pupil The Ocular Surface: Where Research Meets and Greets BusinessĬataract Surgery in an Eye With Blunt Trauma, Glaucoma, and Zonular WeaknessĪ Healthy Tear Film Equals a Happy PatientĬataract Surgery On Eyes With Small Pupils ![]()
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