Silodosin as a predisposing factor of intraoperative floppy iris syndrome (IFIS): an observational propensity score-matching cohort study.

PURPOSE: To evaluate the correlation between silodosin and intraoperative floppy iris syndrome (IFIS) and compare it with other a1-adrenergic receptor antagonists (a1-ARAs) and other factors predisposing to IFIS. METHODS: From the patients who underwent phacoemulsification between 2014 and 2020, we identified all patients who, during their preoperative assessment, reported an a1-ARAs intake (exposed group). These patients were matched utilizing a propensity score matching analysis with an otherwise homogenous group of patients (control group) based on demographics and systemic/ocular comorbidities. RESULTS: A total of 350 patients were included in each group. In the exposed group, 177 (50.6%) patients were exposed to tamsulosin, 105 (30%) to alfuzosin, 43 (12.2%) to silodosin. Regarding IFIS, it was observed in 21.5% of patients on tamsulosin (38/177), 11.4% on alfuzosin (12/105), 37.2% on silodosin (16/43), and 3.4% in the controlled group (12/350). In a multiple regression model analysis, the only two factors significantly associated with IFIS development were silodosin and tamsulosin yielding an adjusted odds ratio of 8.471 (95%CI 4.005-17.920) and 3.803 (95%CI 2.231-6.485), respectively. CONCLUSION: Silodosin has been demonstrated as a predisposing factor, strongly correlated with IFIS development. These results should increase cataract surgeons' awareness to assess their patients preoperatively for exposure to silodosin carefully and employ the appropriate prophylactic measures to ameliorate the impact of silodosin intake on the surgical outcome.

Efficacy and effect of intracameral adrenaline infusion on pulse rate and blood pressure during phacoemulsification in patients with dark irides.

OBJECTIVE: Phacoemulsification is the most common cataract surgery that needs optimum circumstances in the field of surgery. This comparative pre- and postoperative study assessed the efficacy and safety of using adrenaline in the irrigating solution as an adjunct to preoperative topical mydriatics in dark irides during Phaco surgery. PATIENTS AND METHODS: This was a prospective observational study that enrolled 421 cataract patients (421 eyes) with dark irides, who were scheduled for Phaco surgery from January 2019 to August 2020. All patients received intraoperative irrigation of a balanced salt solution containing adrenaline. The pulse rate and systolic and diastolic blood pressure of all patients were recorded pre- and postoperatively. In addition, the presence of intraoperative floppy-iris syndrome (IFIS), need for pupil mechanical dilatation, and incidence of posterior capsular rupture were recorded. RESULTS: The sample consisted of 421 patients (421 eyes) all had dark irides. Pulse rate and systolic and diastolic blood pressure did not significantly increase post-operatively (p <0.001). Mechanical dilatation of the pupil was performed in one patient (0.24%) and seven eyes (1.66%) were found to have IFIS. There was no case of posterior capsule rupture. CONCLUSIONS: In comparison with the use of preoperative topical mydriatics alone, adding intracameral adrenaline to the irrigation fluid maintains better pupillary dilatation throughout Phacoemulsification surgery, thereby providing better clinical outcomes in dark irides, even in those with IFIS. Its use has no incremental effect on either blood pressure or pulse rate.

The prevalence and break down of narrow anterior chamber angle pathology presenting to a general ophthalmology clinic.

ABSTRACT: To approximate the breakdown of narrow anterior chamber angle conditions, on general ophthalmology clinics, in the predominantly white population of the South East Kent region in the United Kingdom.A review was done of all patients attending a secondary care ophthalmology general clinic over a 3-year period. Patients were assessed with: slitlamp biomicroscopy with indentation gonioscopy; SD optical coherence tomography, Humphrey visual field analyzer, and high frequency ultrasound and categorized into various narrow angle conditions. These were: narrow Van Herrick but open angle; primary narrow angle but nonoccludable; primary angle closure suspect; primary angle closure; chronic narrow angle glaucoma; plateau iris configuration; plateau iris syndrome, and phacomorphic narrow angle.A total of 14,520 patients were referred to the clinic, of those 10,491 attended and were analyzed. Six hundred seventy four (6.4%) of the patients had some form of narrow angle condition in at least 1 eye. The majority of these patients were at relative low risk of pathology such as nonoccludable narrow angles (359/53.3%) and narrow Van Herrick but open angles (93/13.8%). 8.8% of all the narrow angle patients had primary angle closure suspect or primary angle closure. Plateau iris pathology was seen in 68 (10.1%) of patients with 18 (26%) having confirmed plateau iris syndrome after peripheral iridotomy. Phacomorphic pathology was confirmed in 75 (11.1%) patients.Narrow angle patients form a significant proportion (6.4%) of those attending general ophthalmology clinic in the predominantly white population in the South East Kent Region of the United Kingdom. The majority of these (67.1%) are at a relatively low risk of developing acute or chronic angle closure glaucoma. Of the remaining patients 8.8% have primary angle closure suspect or primary angle closure and 2.9% have already progressed to chronic narrow angle closure glaucoma. Plateau iris pathology and phacomorphic glaucoma account for the remainder of the presentations.

Preoperative ocular characteristics predicting the development of intraoperative floppy iris syndrome regardless of alpha-antagonist exposure status.

PURPOSE: To assess structural risk factors for intraoperative floppy iris syndrome (IFIS) available on preoperative examination before cataract surgery. METHODS: In this retrospective study, medical records of patients who underwent cataract surgery in Shamir Medical Center, between July and September 2019, were reviewed. Patients younger than 50 years, with preexisting ocular conditions affecting the pupillary size or anterior chamber depth (ACD), and combined procedures were excluded. Association of IFIS with preoperative ocular parameters was tested using uni- and multivariant analyses. RESULTS: Overall, 394 eyes of 394 patients were included. The mean age was 72.48 ± 8.63 years, and 58.4% were female. IFIS occurred in 18 eyes (4.6%), seven (38.89%) of which had been previously treated with alpha-antagonists. Patients in the IFIS group were significantly older compared with those in the non-IFIS group (78.1 ± 6.7 vs. 72.2 ± 8.6 years, P = 0.005), with no significant gender difference. The mydriatic pupil diameter was significantly smaller in the IFIS group (5.73 ± 1.16 vs. 6.97 ± 1.03 mm, P < 0.001), and the lens thickness (LT) was larger (4.93 ± 0.42 vs. 4.49 ± 0.42 mm, P = 0.001). ACD was inversely correlated with LT (r = - 0.613, P < 0.001) and positively correlated with pupil diameter (r = 0.252, P < 0.001). On univariate analysis, ACD was significantly shallower in the IFIS group (2.88 ± 0.49 vs. 3.14 ± 0.39 mm, P = 0.008). In multivariant analysis controlling for alpha-antagonist use, both LT and mydriatic pupil diameter remained significantly predictive of IFIS (LT: OR 9.9, 95%CI 1.9-49, P = 0.005; pupil diameter OR 0.427, 95%CI 0.26-0.69, P < 0.001). CONCLUSIONS: Increased LT and decreased mydriatic pupil diameter were associated with increased IFIS risk regardless of alpha-antagonist treatment status.

Prevalence of Plateau Iris Syndrome among Patients Presenting with Primary Angle Closure and Primary Angle-Closure Glaucoma in a Tertiary Eye Care Hospital.

PURPOSE: Glaucoma is a leading cause of visual impairment worldwide, and plateau iris syndrome (PIS) is the most common nonpupillary block mechanism of angle closure. This study aims to assess the prevalence of PIS among Saudi population. METHODS: It is a prospective observational study that examined patients previously diagnosed with chronic angle closure. Those patients already underwent peripheral laser iridotomy (PLI) and were assessed clinically and by ultrasound biomicroscopy (UBM). RESULTS: A total of 147 eyes in 77 patients were included in this study. The mean age among subjects was 61.2 years, and almost 69% were females. Chronic angle closure was noted to be bilateral in 91% of patients, whereas 5% had their left eye involved and 4% had right eye involved. The mean intraocular pressure (IOP) before PLI and after laser treatment was 19.3 and 16.2, respectively. The mean visual acuity before and after PLI was 0.3 logMAR. After UBM examination, plateau iris was found in 41.5% of subjects. The anterior chamber (AC) depth was noted to be deeper in PIS patients (P = 0.046). Other risk factors were observed in our study including place of residency (P = 0.048) and preintervention IOP (P = 0.032). CONCLUSION: PIS is the most common mechanism of nonpupillary block angle closure. In addition to clinical findings, UBM is important to reach the appropriate diagnosis. This study reviewed the prevalence of PIS with the aid of UBM; it was found consistent with previous reports. In addition, PIS risk factors included AC depth, place of residency, and preintervention IOP.

Clinical, Demographic, and Tomographic Aspects Related to Iris Mammillations Among Patients With Keratoconus: A Cross-Sectional Study.

PURPOSE: Iris mammillations (IM) were previously described in patients with keratoconus, but the clinical implications of this finding have never been studied. Our aim was to investigate demographic, tomographic, and clinical characteristics potentially associated with the presence of IM among patients with keratoconus. METHODS: This was a cross-sectional study performed among patients with keratoconus in a public-affiliated university hospital. All patients under follow-up were considered eligible to participate in the study. Participants were evaluated by 2 trained ophthalmologists and submitted to corneal tomography (Pentacam). Selected demographic, clinical, and tomographic characteristics were assessed and compared among participants with IM (IM group) and without IM (No-IM group) using the Wilcoxon test or 2-tailed Fisher exact test, as appropriate. RESULTS: The study population consisted of 106 subjects and 19 (17.9%) presented with IM. The median age and interquartile range were 18 years old (14-24) in the IM group and 20 years old (17-24) in the No-IM group (P = 0.135). The female proportion was 47.3% in the IM group and 52.8% in the No-IM group (P = 0.801). Median (interquartile ranges) pachymetric values of the right eyes were 498 (466-525) for the IM group and 459 (421-482) for the No-IM group (P = 0.005). For the left eyes, the values were 490 (456-523) in the IM group and 450 (418-485) in the No-IM group (P = 0.024). CONCLUSIONS: Subjects with keratoconus presenting with IM have thicker corneas than those without IM. Follow-up studies should be performed to evaluate the clinical implications of this finding.

Clinical risk factors associated with intraoperative floppy iris syndrome: a prospective study.

PURPOSE: To evaluate the incidence of and factors associated with intraoperative floppy iris syndrome (IFIS) in patients undergoing cataract phacoemulsification. METHODS: In total, 319 eyes of 319 patients who underwent phacoemulsification with implantation of an intraocular lens (IOL) into the posterior chamber were included in this study. Direct injection of epinephrine into the anterior chamber was performed in all cases. The following patient information was collected: gender, age, axial length of the eye, presence of pseudoexfoliation syndrome, glaucoma, diabetes mellitus, hypertension, current use of medications including alpha1 adrenergic receptor antagonists (alpha1-ARAs), finasteride, and benzodiazepines, duration of intake of alpha1-ARAs and finasteride, and duration of the surgery. Patients were classified as IFIS or non-IFIS after the surgery. Univariate and multivariate logistic regression analyses were performed. RESULTS: The overall incidence of IFIS was 9.09% (29/319 eyes). The multivariate analysis revealed that tamsulosin use (P = 0.004), finasteride use (P = 0.014), and increasing age (P = 0.006) were significantly associated with IFIS. Male gender and benzodiazepine use were significantly associated with IFIS in the univariate analysis, but not in the multivariate analysis. The non-selective alpha1-ARA doxazosin was not found to be associated with IFIS. CONCLUSIONS: The findings suggest that finasteride use and aging are risk factors for IFIS and confirm the association of tamsulosin use with IFIS. Further, doxazosin appears to be a relatively safe drug with respect to the occurrence of IFIS.

The role of sex in intraoperative floppy-iris syndrome.

PURPOSE: To compare the incidence of intraoperative floppy-iris syndrome (IFIS) between male and female patients undergoing phacoemulsification cataract surgery, evaluate risk factors for its appearance in each sex, and assess any differences in the final visual outcomes. SETTING: 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Greece. DESIGN: Comparative retrospective case-control study. METHODS: Cataract patients with recorded IFIS of any severity occurring over 4 years in a tertiary care ophthalmic center during phacoemulsification surgery were identified and enrolled in a multivariate analysis. RESULTS: The study comprised 3811 eyes of 3213 patients. Of the 1678 female patients (1937 eyes) undergoing cataract surgery, IFIS was observed in 25 eyes (1.29%), whereas the incidence of IFIS in male eyes during the same period was statistically significantly higher (97 [5.17%] of 1874 eyes) (P < .0001). No statistically significant difference in age was found between male patients (72.92 years ± 6.5 [SD]) and female patients (72.04 ± 7.1 years) (P = .56). An intake of α1-receptor blockers was identified in 70 (72.2%) of 97 male IFIS cases and in none of the 25 female IFIS cases (P < .0001). The posterior capsule rupture rate was significantly higher in 7 (28%) of the 25 female IFIS cases compared with 9 (9.28%) of the 97 male IFIS cases (P = .02). The posterior capsule rupture incidence and final corrected distance visual acuity (with spectacles) were shown to correlate with the IFIS severity grade only in female patients (P < .001 and P = .02, respectively). CONCLUSIONS: Although the incidence of IFIS is rarer in female patients, it might significantly affect an increase in the intraoperative events rate and affect the final visual outcome correlating with the severity grade of its appearance. Predisposing risk factors differ between the sexes and surgeons should always be aware of the potentially catastrophic consequences of unforeseen IFIS.

Implantable collamer lens surgery in patients with primary iris and/or ciliary body cysts.

BACKGROUND: The prevalence of primary iris and/or ciliary body cysts is common in myopia, though asymptomatic in nearly all cases. It's a very valuable thing to study the clinical safety and reliability of implantable collamer lens (ICL) surgery in patients with primary iris and/or ciliary body cysts. METHODS: A total of 108 patients (201 eyes) were included in this retrospective study. All eyes had been implanted with V4c implantable collamer lens (ICLV4c). According to the eyes with or without primary iris and/or ciliary body cysts, all eyes were divided into two groups. We observed preoperative and postoperative uncorrected distance visual acuity (UDVA), corrected distance visual acuity)(CDVA), intra-ocular pressure(IOP), anterior chamber volume(ACV), anterior chamber depth(ACD), trabecular-iris angle (TIA), angle opening distance at 500 µm (AOD500),vertical central distance between the corneal endothelium and the front surface of ICL(CE-ICL), and the central vault. The follow-up periods covered 12 months. RESULTS: Among all the 201 eyes, primary iris and/or ciliary body cysts were detected in 54 eyes (26.87%),but the prevalence was account to 36.11%(18males,21females).There were 30 eyes (55.56%) with unilateral single cyst, 12 eyes (22.22%) with unilateral double cysts, 12 eyes (22.22%) eyes with unilateral multiple and/or multi-quadrants cysts, the mean size of cysts was (0.714 ± 0.149)mm(range from 0.510 to 1.075 mm).30.4% of the cysts were located at iridociliary sulcus, 65.5% in pars plicata, and 4.1% in midzonal iris, which showed a characteristic distribution pattern, with cysts found predominantly in the inferior and temporal quadrants.The postoperative size and the number of cysts showed nearly no changes. The postoperative ACV, AOD500 and TIA showed a statistical reduction in both two groups (P < 0.05), but with no statistical significant between the two groups (P > 0.05), the parameters of postoperative IOP,CE-ICL and central vault also showed the same results as which. We did not observe serious complication and IOP elevating in the whole follow-up periods. CONCLUSION: Primary iris and/or ciliary body cysts are not absolutely contraindication for ICL surgery. For some single cyst smaller than 1.075 mm or single quadrant cysts located at ciliary body are rare to lead some serious complications. But, for some multiple cysts, especially multi-quadrants cysts located at iridociliary sulcus, we still should remain cautions.

Efficacy and safety of low-concentration, bisulphite-containing, intracameral epinephrine and topical atropine treatments for the prevention of intraoperative floppy iris syndrome.

PURPOSE: The aim of this study was to evaluate the efficacy and safety of topical atropine and topical atropine combined with intracameral low-concentration, bisulphite-containing epinephrine treatment for the prophylaxis of intraoperative floppy iris syndrome. MATERIALS AND METHODS: Seventy-two eyes of 55 male patients who were treated with alpha-adrenergic antagonist medications for benign prostatic hyperplasia were included in this study. Standard premedication with topical cyclopentolate, phenylephrine, tropicamide and ketorolac was applied to all of the patients. In 22 cases no further prophylactic method was used (Group-NP), while in 29 cases topical atropine drops was instilled 12 h and 30 min before surgery (Group-A) and in 21 cases 1:16 000 epinephrine was injected to the anterior chamber at the beginning of surgery (Group-EA) in addition to topical atropine prophylaxis. RESULTS: In Group-NP, 62.8% of the cases developed IFIS, while development of IFIS was significantly lower in Group-A (17.2%, p = 0.0004) and Group-EA (9.5%, p < 0.0001). Posterior capsule rupture was observed in two cases (9.1%) in Group-NP, in one case (3.4%) in Group-A and was not observed in Group-EA. There was no statistically significant difference between the groups for the development of surgical complications. We did not observe any adverse events or significant endothelial cell loss (p = 0.462). CONCLUSIONS: Our results indicate that preoperative use of topical atropine reduces the incidence of IFIS. Use of low-concentration, bisulphite-containing epinephrine is more effective in the prevention of IFIS and does not cause preservative related endothelial damage. This prophylaxis may be preferred when preservative free epinephrine is not available.

Plateau Iris Distribution Across Anterior Segment Optical Coherence Tomography Defined Subgroups of Subjects With Primary Angle Closure Glaucoma.

Purpose: We previously identified three distinct subgroups of patients with primary angle closure glaucoma (PACG) based on anterior segment optical coherence tomography (ASOCT) imaging. Group 1 was characterized by a large iris area with deepest anterior chambers, group 2 by a large lens vault (LV) and shallow anterior chamber depth (ACD), and group 3 displayed intermediate values across iris area, LV, and ACD. The purpose of the present study was to determine the distribution of plateau iris in these subgroups using ultrasound biomicroscopy (UBM) features. Methods: UBM images of the 210 subjects who were previously enrolled for the ASOCT subgrouping analysis and had undergone laser peripheral iridotomy were assessed and graded by a single glaucoma fellowship trained clinician. Plateau iris was defined as the presence of all the following UBM criteria in at least two quadrants: anteriorly directed ciliary body, absent ciliary sulcus, iris angulation, flat iris plane, and iridoangle touch. Results: Of 210 subjects, 23 were excluded due to poor-quality images. Based on standardized UBM criteria, the overall prevalence of plateau iris was 36.9% (n = 187). The proportion of plateau iris was similar across the three groups (subgroup 1:35.4% (n = 29); subgroup 2:39.0% (n = 32); subgroup 3:34.8% (n = 8), P = 0.87). On multiple logistic regression analysis, iris thickness at 750 µm from the scleral spur (IT750) was the only variable associated with plateau iris (odds ratio: 1.5/100 µm increase in iris thickness [IT], P = 0.04). Conclusions: The proportion of plateau iris was similar across the three ASOCT-based PACG subgroups and more than one-third of subjects with PACG were diagnosed with plateau iris based on standardized UBM criteria. In addition, we noted that eyes with increased peripheral IT have an increased likelihood of plateau iris.

[Rare causes of childhood leukocoria]. / Les causes rares de leucocorie chez l'enfant.

PURPOSE: The purpose was to record the causes of leukocoria among children under 10years of age and to determine the proportion of rare causes of leukocoria. PATIENTS AND METHODS: This retrospective study was conducted over a period of ten years, from January 1, 2004 to December 31, 2013, in patients under 10years of age who were referred for leukocoria. RESULTS: Leukocoria represented one of the ten reasons for consultation among children under 10years of age. The mean age of our patients was 42.5months. In 76 % of cases, the leukocoria patients were children under 6years of age. Male patients were affected more commonly, with a sex-ratio of 1.5. Patients coming from Dakar and its suburbs represented two thirds of the total. Bilateral involvement represented 53.7 % of the total. Cataracts were responsible for 74.3 % of cases, retinoblastoma 20.58 %, retinal detachment 0.96 %, retinopathy of prematurity 0.96 %, pupillary membrane persistence 0.96 %, persistent hyperplastic primary vitreous 0.64 %, endophthalmitis 0.64 %, optic nerve coloboma 0.32 %, iris heterochromia 0.32 % and ametropia 0.32 %. DISCUSSION: The total percentage of rare causes was 5.12 % in our study, including one case of hyperopia. These etiologies, although rare, do exist. CONCLUSION: Rare causes of leukocoria require special attention. The discovery of leukocoria necessitates rigorous etiological work-up. Ametropia must be a diagnosis of exclusion.

The Incidence and Risk Factors of Lens-iris Diaphragm Retropulsion Syndrome during Phacoemulsification.

PURPOSE: In the present study, the incidence and risk factors of lens-iris diaphragm retropulsion syndrome (LIDRS) were evaluated. METHODS: Patients who underwent cataract surgery using phacoemulsification between June 2014 and December 2014 were included in the study. The preoperative ocular biometric and intraoperative surgical parameters were examined. The incidence of LIDRS and various risk factors were analyzed using an independent t-test, Pearson's chi-square test, and univariable and multivariable logistic regression analyses. RESULTS: Among 124 eyes of 124 patients, 100 (80.6%) had no LIDRS and 24 (19.4%) had LIDRS. LIDRS occurred in 13 of 31 vitrectomized eyes (41.9%) and 11 of 93 non-vitrectomized eyes (11.8%). Based on univariable analysis, age (odds ratio [OR], 0.920; p = 0.001), vitrectomized eye (OR, 5.038; p = 0.001), spherical equivalent (OR, 0.778; p < 0.001), axial length (OR, 1.716; p < 0.001), anterior chamber depth (OR, 3.328; p = 0.037), and 3.0 mm vs. 2.2 mm incision size (OR, 4.964; p = 0.001) were statistically significant risk factors associated with the development of LIDRS. Conditional multivariable logistic regression showed that vitrectomized eye (OR, 3.865; 95% confidence interval [CI], 1.201 to 12.436; p = 0.023), long axial length (OR, 1.709; 95% CI, 1.264 to 2.310; p = 0.001), and 3.0 vs. 2.2 mm incision size (OR, 3.571; 95% CI, 1.120 to 11.393; p = 0.031) were significant independent risk factors associated with LIDRS. CONCLUSIONS: LIDRS is a relatively common occurrence and was found to be associated with vitrectomized eye, long axial length, and larger incision size. Evaluating risk factors prior to cataract surgery can help reduce associated morbidity.

Intraoperative floppy iris syndrome and its association with various concurrent medications, bulbus length, patient age and gender.

PURPOSE: To evaluate the association between intraoperative floppy iris syndrome (IFIS) and concurrent medications containing selective alpha1A receptor antagonists as well as nonselective alpha1-adrenergic receptor antagonists, bulbus length, patient age and gender. METHODS: We performed a prospective data acquisition of IFIS occurrence and grading, and retrospective evaluation of concurrent medications, bulbus length, patient age and gender of all patients undergoing cataract surgery over a 6-month period. RESULTS: IFIS was observed in 119 of 947 cases (12.6 %). 31 of those 119 patients (26.1 %) had a concurrent medication with a drug that is associated with a higher risk of causing IFIS. Tamsulosin was the drug most commonly associated with IFIS (n = 11), followed by a combination of drugs (n = 7), doxazosin (n = 4), quetiapine (n = 4), finasterid (n = 2), prothipendyl (n = 2), and mianserin (n = 1). Bulbus length and age did not show any significant association with occurrence or grade of IFIS. Gender distribution among IFIS cases was 57.1 % males (n = 68) and 42.9 % (n = 51) females. CONCLUSIONS: The occurrence of IFIS has to be expected with a variety of concurrent medications. The number of IFIS cases and the percentage of females in this series are higher compared to previous reports. The observations might be due to a rising awareness of surgeons or to an increasing number of causative medications on the market.

Risk factors for intraoperative floppy iris syndrome: a prospective study.

PurposeTo evaluate risk factors for intraoperative floppy iris syndrome (IFIS) in patients undergoing phacoemulsification.MethodsParticipants in the study were 1274 consecutive patients, who underwent routine phacoemulsification cataract surgery. The following data were recorded and evaluated as possible risk factors: ophthalmological conditions, axial length of the eye, sociodemographic features, clinical data (hypertension and diabetes mellitus), medications being taken at the time of surgery, and duration of their intake. Cases were characterized intraoperatively as IFIS and non-IFIS. Univariate and multivariate logistic regression analysis were performed.ResultsIFIS was observed in 63/1274 eyes (4.9%, 95% CI: 3.9-6.7%). Current use of tamsulosin, alfuzosin, terazosin, benzodiazepines, quetiapine, and finasteride, as well as hypertension, were all independently associated with IFIS. Significant associations were noted for male sex, rivastigmine, and short axial length, which did not reach significance at the multivariate analysis. Duration of α-blockers intake was not found to be associated with IFIS.ConclusionApart from the well-established associations with α-blockers, this prospective study points to benzodiazepines, quetiapine, finasteride, and hypertension as potential risk factors for IFIS. Short axial length and rivastigmine were significantly associated with IFIS only at the univariate analysis.

Iris alterations after DSAEK. / Alteraciones iridianas tras Queratoplastia endotelial automatizada con stripping de la Descemet.

OBJECTIVE: To evaluate a series of case that developed iris changes after performing Descemet's stripping automated endothelial keratoplasty (DSAEK). METHODS: Retrospective study of eyes that developed iris abnormalities, such as pupil ovalisation, iris atrophy, iridocorneal synechiae, mydriatic pupil, and pigmentary changes after performing DSAEK in a tertiary hospital. RESULTS: In a series of the first 32 DSAEK procedures performed, new single or mixed iris alterations were observed in 12 eyes (37.5%). Iris-corneal synechiae were observed in 7 eyes, corectopias in 9 eyes, iris atrophy in 3 cases, and one case developed an areflexic mydriatic pupil. Long-term pigment dispersion at the edge of the lenticule was observed in 12 eyes. The alterations occurred after three months from the surgery. In the evaluation of the associated factors, malignant glaucoma had occurred in 1 case, 2 eyes had required a second surgery, one case by re-DSAEK, and the other one by removing the intraocular lens due to lens opacification. Two cases had a shallow anterior chamber. No relationship was found between the thickness of the peripheral lenticule and the presence of synechiae. CONCLUSION: Iris changes regarding DSAEK are possible. A discussion is presented on the relationship between increased intraocular pressure due to air in anterior chamber and its relationship with ischaemia and secondary alterations in the iris.

Golden retriever cystic uveal disease: a longitudinal study of iridociliary cysts, pigmentary uveitis, and pigmentary/cystic glaucoma over a decade in western Canada.

OBJECTIVES: To determine the incidence of iridociliary cysts, pigmentary uveitis (PU)/pigmentary cystic glaucoma (PCG) in golden retriever dogs in western Canada, the progression of iridociliary cysts to PU/PCG, and a mode of inheritance for this disorder. ANIMAL STUDIED: A total of 830 golden retriever dogs from Alberta, Saskatchewan, and Manitoba from 2004 to 2014 were studied. PROCEDURE: Data were compiled from Canine Eye Registry Foundation (CERF) or Orthopedic Foundation for Animals (OFA) records (n = 630) and clinical consultations (n = 200) for a retrospective assessment of iridociliary cysts, PU, and PCG. RESULTS: Total incidence of iridociliary cysts and PU from CERF/OFA data were 4.8% (n = 30/630) and 5.9% (n = 37/630), respectively. Incidence of PU increased with ages >4 years (12.7%, n = 32/251). Dogs diagnosed with thin-walled, attached iridociliary cysts had a high risk of being diagnosed with PU or PCG upon re-examination (56.5%, n = 13/23). No dogs diagnosed with thick-walled, anterior chamber cysts (n = 7) developed PU or PCG within the time frame of the study. Data from clinical consultations confirmed that PU carried a poor prognosis for the affected eyes as 44.9% (n = 22/49) of dogs progressed to PCG. PU- and PCG-affected dogs followed a familial pattern and there was an association with thin-walled iridociliary cysts. Pedigree analysis suggested an autosomal dominant mode of inheritance with partial penetrance. CONCLUSIONS: Thin-walled iridociliary cysts are associated with PU and PCG. All breeding golden retriever dogs should be examined annually by an ophthalmologist. The incidence of this disorder is higher in western Canada than previous reports in North America.

Intraoperative floppy iris syndrome ­ epidemiology and clinical assessment.

Purpose: To assess the incidence, and to identify medications and clinical features associated with intraoperative floppy iris syndrome in patients undergoing cataract surgery. Material and methods: The non-randomized, observational, prospective study was performed in 616 eyes (610 patients) after cataract surgery to determine the incidence of intraoperative floppy iris syndrome and the medications associated with its higher prevalence. We used a slit lamp adapted optical coherence tomography to evaluate anterior segment of 155 eyes (154 patients), measuring pupil diameter before and after the use of mydriatics and assessing the pre-dilated iris thickness at the dilator and sphincter muscle region. Results: The overall incidence of intraoperative floppy iris syndrome was 4% (25/616 eyes). The highest prevalence of intraoperative floppy iris syndrome was shown in patients exposed to tamsulosin (39%). Pupil diameter in mm before and after mydriasis was significantly smaller in patients with intraoperative floppy iris syndrome as compared to the syndrome-free ones (pre-dilated ­ 1.85 ± 0.43 vs. 2.16 ± 0.37; p < 0.01; dilated ­ 5.04 ± 1.01 vs. 5.70 ± 0.87; p < 0.01). The thickness of the iris in sphincter muscle region in µm was similar in patients with and without intraoperative floppy iris syndrome (520.3 ± 76.1 vs. 520.6 ± 72.4; p > 0.05). Significantly thinner iris in dilator muscle region was found in patients with intraoperative floppy iris syndrome as compared to the syndrome-free ones (409.9 ± 55.7 vs. 448.6 ± 55.8; p < 0.05). The presence of intraoperative floppy iris syndrome was correlated with a higher risk of intraoperative complications. Conclusions: Patients with intraoperative floppy iris syndrome have decreased pupil diameter and a thinner iris in dilator muscle region. Slit lamp optical coherence tomography is a useful device to preoperatively detect clinical features associated with intraoperative floppy iris syndrome. These findings may warn the surgeon of potential intra-operative difficulties. Slowa kluczowe: zespól sródoperacyjnie wiotkiej teczówki (IFIS), epidemiologia, operacja zacmy, optyczna koherentna tomografia skojarzona z lampa szczelinowa (sl-OCT).

Appositional angle closure in Chinese with primary angle closure and primary angle closure glaucoma after laser peripheral iridotomy.

PURPOSE: To determine the prevalence of appositional angle closure (AAC) after laser peripheral iridotomy (LPI) in the eyes of Chinese patients with primary angle closure (PAC) and primary angle closure glaucoma (PACG) and to evaluate its pathogenesis by investigating anatomic characteristics. METHODS: This was a cross-sectional observational study. PAC and PACG subjects were consecutively enrolled after LPI. Ultrasound biomicroscopy (UBM) images, obtained in darkness, of each quadrant without peripheral anterior synechia (PAS) under gonioscopy were qualitatively assessed. Darkroom provocative test (DRPT) was also performed. RESULTS: A total of 134 eyes of 134 patients were enrolled. AAC was observed in ≥ 1 quadrant of UBM image in 85 subjects (63.4%). There were 116 randomly selected quadrants without PAS for 134 patients (86.6%). AAC existed in 38 quadrants (32.8%). Among these, plateau iris accounted for 44.7%, anteriorly inserted iris for 13.2%, thick iris for 13.2%, and anteriorly inserted iris combined with thick iris for 18.4% of the total. One hundred fifteen patients underwent DRPT and its positive rate of eyes with AAC ≥ 2 quadrants (37.5% [12 of 32 patients]) was significantly higher than those ≤ 1 quadrant (16.9% [14 of 83 patients]; P = 0.018). However, no significant differences were found between eyes with nonsynechia plateau iris ≥ 2 quadrants (36.4% [4 of 11 patients]) and those ≤ 1 quadrant (21.2% [22 of 104 patients]; P = 0.266). CONCLUSIONS: Approximately two-thirds of PAC and PACG eyes of Chinese patients after LPI had AAC. Plateau iris accounted for less than 50% of AAC. Other factors such as a thick peripheral iris and an anteriorly inserted iris also contributed to AAC. DRPT results suggested AAC might have more functional meaning than plateau iris.