Numerous strategies may be needed to control IFIS

Article

Intraoperative floppy iris syndrome (IFIS) can be approached in a number of ways depending on the surgical scenario, according to David Chang, MD, University of California, San Francisco.

Intraoperative floppy iris syndrome (IFIS) can be approached in a number of ways depending on the surgical scenario,according to David Chang, MD, University of California, San Francisco.

"There is great variability in how the iris responds among patients with IFIS," Dr. Chang said. "We have to control it, or itmay or may not work, which is why multiple strategies are needed."

The first approach that he uses, an ophthalmic viscosurgical device (OVD), provides good pupillary dilation in patients whoare taking tamsulosin (Flomax, Boehringer Ingelheim Pharmaceuticals), as Dr. Chang demonstrated in a mild case of IFIS.Gentle hydrodissection, horizontal chopping, and low flow are advised in these cases, he said. The key to using an OVD is toprolong its duration in the eye. He achieves visco mydriasis by refilling the eye with a proprietary OVD, 2.3% sodiumhyaluronate (Healon5, Advanced Medical Optics), as needed. However, he noted, there is a learning curve associated with theuse of this OVD.

Another strategy in patients with IFIS in whom an OVD alone may not work is the use of intracameral epinephrine, whichprovides pupillary rigidity and eliminates any billowing of the iris. In these cases, epinephrine is mixed with balanced saltsolution in a 1:4 ratio. Dr. Chang demonstrated a case in which epinephrine was used, there was no prolapse, and the irisbillowing stopped. In cases of severe IFIS, epinephrine may need more time to work.

When epinephrine is ineffective, Dr. Chang reported that he combines 2.3% sodium hyaluronate and epinephrine to dilate thepupil successfully.

In patients with a small pupil, iris retractors (available from Katena and FCI) may be used when intracameral epinephrine isineffective. Dr. Chang makes a separate stab incision from the phaco incision. The retractor forms the iris in a diamondconfiguration, which eliminates tenting of the iris and provides good exposure nasally for chopping.

The latest strategy is the disposable expansion ring. This device provides a 6-mm pupil diameter. The ring has a low profileallowing for easy access of the instrument to the eye. Dr. Chang said that, in his opinion, he considers one proprietary ring(Malyugin Ring, Microsurgical Technologies) to be among the easiest devices to use.

Newsletter

Join ophthalmologists across Europe—sign up for exclusive updates and innovations in surgical techniques and clinical care.

Recent Videos
Robert Sergott, MD, describes fluorescence lifetime imaging ophthalmoscopy (FLIO) and the International SPECTRALIS Symposium – And Beyond (ISS) in Heidelberg, Germany.
Rayaz Malik, MBChB, PhD, a professor of medicine at Weill Cornell Medicine - Qatar, spoke with Ophthalmology Times Europe about his presentation. It's titled "An eye on neurodegenerative diseases: Challenging the dogma" at the International SPECTRALIS Sympsoium. In conversation with Hattie Hayes, Ophthalmology Times Europe
Anat Loewenstein, MD, describes her presentation on remote imaging for age-related macular degeneration and geographic atrophy at the International SPECTRALIS Symposium, in conversation with Hattie Hayes of Ophthalmology Times Europe
Tyson Brunstetter, OD, PhD, a US Navy Aerospace Optometrist at the NASA Johnson Space Center in Houston, Texas, shares key takeaways from his keynote at the International SPECTRALIS Symposium (ISS)
Rayaz Malik, MBChB, PhD, shares his presentation, titled An eye on neurodegenerative diseases: Challenging the dogma, at this year's International SPECTRALIS Symposium
At the Retina World Congress, Siegfried Priglinger, MD, speaks about ensuring the best outcomes for preschool-aged patients
At the 2025 ASCRS meeting, Robert Ang, MD said small aperture IOLs can benefit all patients, especially those with complex corneas or who have undergone previous corneal refractive surgery
Viha Vig, MBChB graduate student at the University of Auckland, New Zealand, discusses her poster presentation on the relationship between mitochondiral disease, Alzheimer disease, and other types of dementia.
Alfredo Sadun, MD, PhD, chief of Ophthalmology at the Doheny Eye Institute, University of California Los Angeles, shared exciting new research with the Eye Care Network during the Association for Research in Vision and Ophthalmology (ARVO) meeting on the subject of Leber hereditary optic neuropathy (LHON).
Related Content
© 2025 MJH Life Sciences

All rights reserved.