Risk Factors For The Development Of Floppy Iris Syndrome: An Up-To-Date Meta-Analysis

Intraoperative Floppy Iris Syndrome (IFIS) is an increasingly recognized condition that is proven to lead to higher rates of intraoperative complications. This study provides an updated systematic review and meta-analysis regarding all the identified factors predisposing to IFIS. 

2nd Department of Ophthalmology, Aristotle Unoversity of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece

The study was performed in accordance with the PRISMA guidelines. 38 studies were finally included in the meta-analysis. Meta-analysis was carried out to estimate the association of each variable with the occurrence of IFIS. Based on the extracted data, odds ratios (ORs) and 95% confidence intervals (CIs) were either calculated by constructing 2x2 tables for each categorical outcome or extracted from univariable logistic regression analyses reported in the original publications. The random-effects model (DerSimonian-Laird) was adopted to calculate the pooled effect estimates for all variables of interest due to the significant clinical heterogeneity among the included studies.

The factors that were found to predispose to IFIS significantly were male gender(OR=4.25/CI=2.58-7.01), hypertension(OR=1.55/CI=1.01-2.37), tamsulosin(OR=31.06/CI=13.74-70.22), finasteride(OR=4.60/CI=1.97-10.73), benzodiazepines(OR=2.88/CI=1.17-7.12) and antipsychotics intake(OR=6.91/CI=2.22-21.50). A decreased dilated pupil preoperatively was found predisposing to IFIS (weighted mean difference=-0.93/CI=-1.19--0.67]). Intracameral epinephrine which was investigated as a potential prophylactic measure for preventing IFIS, did not reach statistical significance (OR=0.29/CI=0.08-1.06). 

New data that have arisen on factors predisposing to IFIS should be taken into account when estimating the risk of floppy iris appearance during surgery. A comprehensive preoperative assessment of all risk factors is crucial in addressing IFIS since unanticipated IFIS could turn a routine surgery into one of significant visual morbidity.