Document Detail

Pharmacologic pupil dilation as a predictive test for the risk for intraoperative floppy-iris syndrome.
MedLine Citation:
PMID:  21782087     Owner:  NLM     Status:  In-Data-Review    
PURPOSE: To evaluate the effect of α1-adrenergic receptor antagonists (α1-ARAs) on pupil diameter and determine whether the diameter predicts intraoperative floppy-iris syndrome (IFIS).
SETTING: Ophthalmology Section, Palermo University, Palermo, Italy.
DESIGN: Prospective cohort study.
METHODS: Male outpatients taking tamsulosin, α(1)-ARAs, or no α(1)-ARAs having phacoemulsification were recruited. Pupils were measured 1 month preoperatively, immediately preoperatively, and postoperatively under mesopic low (0.4 lux) and high (4.0 lux) illumination after pharmacologic dilation. The IFIS severity was graded.
RESULTS: Each group comprised 50 patients. Pharmacologic dilation in both α(1)-ARA groups was statistically significantly less than in the no α1-ARA group 1 month preoperatively, immediately before surgery, and postoperatively (P=.001, P<.0005, and P<.0005, respectively). The IFIS incidence differed significantly between the tamsulosin and other α(1)-ARA groups and the no α1-ARA group (P<.0005 and P=.017, respectively) and between the tamsulosin group and the other α1-ARA group (P=.027). On regression analysis, the hazard ratio for overall IFIS incidence was 3.8 in the other α(1)-ARA group (P=.012) and 10.1 in the tamsulosin group (P<.0005). Pupil size was inversely related to IFIS incidence and severity (P<.0005). A dilated pupil of 7.0 mm or smaller had 73% sensitivity and 95% specificity for predicting IFIS (P=.0001).
CONCLUSIONS: Pupil dilation was inhibited by α(1)-ARAs, in particular tamsulosin. For a pupil 7.0 mm or smaller, the risk for IFIS existed regardless of α(1)-ARAs treatment, which surgeons should take into consideration.
FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.
Alessandra Casuccio; Giovanni Cillino; Carlo Pavone; Emanuela Spitale; Salvatore Cillino
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of cataract and refractive surgery     Volume:  37     ISSN:  1873-4502     ISO Abbreviation:  J Cataract Refract Surg     Publication Date:  2011 Aug 
Date Detail:
Created Date:  2011-07-25     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8604171     Medline TA:  J Cataract Refract Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1447-54     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.
From the Department of Experimental Biomedicine and Clinical Neuroscience (Casuccio, G. Cillino, Spitale, S. Cillino), Ophthalmology Section, and the Department of Internal Medicine (Pavone), Urology Section, University of Palermo, Palermo, Italy.
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