Risk factors for intraoperative floppy iris syndrome: a prospective study

Eye (Lond). 2016 Aug;30(8):1039-44. doi: 10.1038/eye.2016.122. Epub 2016 Jul 1.


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.

MeSH terms

  • Adrenergic alpha-1 Receptor Antagonists / adverse effects
  • Aged
  • Aged, 80 and over
  • Axial Length, Eye
  • Benzodiazepines / adverse effects
  • Female
  • Finasteride / adverse effects
  • Humans
  • Hypertension / epidemiology
  • Intraoperative Complications*
  • Iris Diseases / chemically induced
  • Iris Diseases / epidemiology*
  • Lens Implantation, Intraocular*
  • Male
  • Phacoemulsification*
  • Prospective Studies
  • Quetiapine Fumarate / adverse effects
  • Risk Factors
  • Sex Factors


  • Adrenergic alpha-1 Receptor Antagonists
  • Benzodiazepines
  • Quetiapine Fumarate
  • Finasteride