Prevention of Floppy Iris Syndrome

Some of the methods of avoiding the consequences of floppy iris syndrome during cataract surgery includes the following:

• Complete patient history: The patient should be asked about intake of medications at the time of surgery as well as in the past.

• Medications: Suspending the use of tamsulosin before surgery is found to be only partially effective. The syndrome can appear even years after discontinuation of the drug. In addition, suddenly stopping tamsulosin may result in urinary retention in the patient with prostate problem.
• Administration of local atropine a few days prior to the surgery has been tried to bring about dilatation of the pupil.

• Introducing adrenaline or phenylephrine in the anterior chamber displaces tamsulosin from alpha receptors and may assist in preventing floppy iris syndrome.
• Mechanical devices: These devices are also known as the mechanical pupil expansion devices. They help in obtaining an adequate area of the pupil by dilating it, prevents it from constricting and prolapse of iris. These include iris retractors, methacrylate rings, silicone rings, Malyugin ring, Graether, Perfect pupil and Morcher ring.

• Ophthalmic viscosurgical devices (OVDs): High density solutions like Healon5 (2.3% hyaluronidate) are sometimes used during cataract surgeries to reduce iris wobbling.