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%).

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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.


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.

This article originally appeared on Ophthalmology Advisor