Managing intraoperative iris syndrome with APX pupil dilator

Trpenoski, Naum and Grekovska, Marija and Kovacevska, Ivona (2021) Managing intraoperative iris syndrome with APX pupil dilator. Knowledge-International Journal 45.4. ISSN 2545-4439

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Abstract

Abstract: The Intraoperative floppy iris syndrome (IFIS) represents the spectrum of iris responses during the surgery of phacoemulsification. IFIS symptoms include: flaccid iris that occurs as a result of normal intraocular fluid, so the iris tissue tends to prolapse through the intraoperative incisions through which cataract extraction is performed and progressive pupillary miosis, which occurs despite standard preoperative therapy for its prevention. In about 2% of patients with cataracts IFIS symptoms occur, complicating the course of the operation and increasing the incidence of complications. The appearance of this syndrome is associated with the use of all drugs from the group of α1-adrenergic blockers, but is much more common with tamsulosin, which is highly selective α1А receptor antagonist and is the most commonly prescribed drug for the treatment of benign prostatic hyperplasia.
The point is to demonstrate the importance of the APX pupillary dilator in cataract surgery in patients with IFIS and systemic therapy with tamsulosin.
The study included 80 patients who were divided into two groups. The first group consisted of 40 patients in whom no mechanical pupillary dilator was used intraoperatively, i.e. it was our control group, and the second group consisted of 40 other patients in whom APX pupillary dilator was used intraoperatively. In all patients there have been noticed: preoperative and postoperative best corrected visual acuity (BCVA), preoperative and intraoperative iris diameter, and the occurrence of intraoperative and postoperative complications.
The occurrence of intra and postoperative complications is of the greatest importance to us and is a measure of the success of cataract surgery with phacoemulsification. We classified IFIS complications during and after cataract surgery as: mild, moderate, and severe. Mild complications include iris prolapse, moderate complications include iris prolapse and transillumination, and severe complications include sphincter rupture, posterior capsule rupture, and anterior chamber vitreous prolapse. In the control group intraoperative complications occurred in 50% and postoperative complications occurred in 40% of the patients. In the second group of patients in whom the APX pupillary dilator was used intraoperatively, there were no intra- and postoperative complications. The values obtained for BCVA and pupillary diameter were not significantly different between the two groups.
Our study demonstrated the high efficacy of the APX dilator for spreading the mitotic pupils and prevention of complications in patients with IFIS.
Keywords: APX ring, Intraoperative floppy iris syndrome (IFIS), Cataract, Тamsulosin®
Field: Medical sciences and Health

Item Type:	Article
Subjects:	Medical and Health Sciences > Clinical medicine
Divisions:	Faculty of Medical Science
Depositing User:	Ivona Kovacevska
Date Deposited:	23 Jun 2021 09:24
Last Modified:	23 Jun 2021 09:24
URI:	https://eprints.ugd.edu.mk/id/eprint/28227

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