Managing Intraoperative Floppy Iris Syndrome in Cataract Surgery

Effective management of intraoperative floppy iris syndrome in cataract surgery involves specific maneuvers such as reducing aspiration flow rate, using mechanical iris expansion devices, and avoiding large or posterior incisions. This condition is characterized by progressive pupil constriction, iris billowing, and iris prolapse, with potential association with pre-surgical pupil dilation. Detailed feedback and references provided for further information.

• Cataract surgery
• Floppy iris syndrome
• Intraoperative management
• Pupil constriction
• Surgical techniques

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1. Quarterly Questions Sample Question Sample Question

2. A patient presenting for cataract surgery is on tamulosin. Which of the following intraoperative maneuvers is most likely Sample Question How would you answer this? Remember, you have 60 seconds to select from the choices listed. Place your screenshot here to decrease the effects of intraoperative floppy iris syndrome? A. B. C. D. Enlarging the corneal incision Placing incremental atropine Creating iris sphincterotomies Reducing the aspiration flow rate 2

3. A patient presenting for cataract surgery is on tamulosin. Which of the following intraoperative maneuvers is most likely to decrease the effects of intraoperative floppy iris syndrome? The platform will tell you instantly how you did. Place your screenshot here Enlarging the corneal incision Placing incremental atropine Creating iris sphincterotomies Reducing the aspiration flow rate A. B. C. D. Your answer is CORRECT. 3

4. Key Point: Intraoperative maneuvers to help reduce the effects of floppy iris syndrome include reducing the aspiration flow rate and vacuum, use of The platform also provides detailed feedback. Place your screenshot here mechanical iris expansion devices, placement of intracameral epinephrine, use of highly retentive viscoelastic, and avoiding an incision that is too large or too posterior (to reduce risk of iris prolapse). The key point addresses the subject matter knowledge necessary to answer the question correctly. 4

5. Critique: Intraoperative floppy iris syndrome is a characterized by the triad of 1) progressive pupil constriction during surgery, 2) billowing of the The critique (discussion) explains why the correct answer is the best choice, followed by reasons the other choices are not appropriate. Place your screenshot here iris, and 3) tendency for iris prolapse into the phacoemulsification and side port incisions during surgery. This triad may or may not be associated with a poorly dilated pupil before surgery 5

6. References: Chang, DF, Osher RH, Wang L, Koch DD. Prospective multicenter evaluation of cataract surgery in patients taking tamsulosin (Flomax). Clickable references to further information about the content of the question are available. Place your screenshot here Ophthalmology 2007;114:957- 964. Flach, A. Intraoperative floppy iris syndrome: Pathophysiology, Prevention and Treatment. Trans Am Ophthalmol Soc 2009;107:234- 39. 6