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IFIS is a complication that may occur during cataract extraction in certain patients.
The syndrome is characterized by a flaccid iris which billows in response to ordinary intraocular fluid currents.
IFIS is defined by progressive pupillary, constriction, and iris prolapse during cataract surgery.
There is a propensity for this floppy iris to prolapse towards the area of cataract extraction during surgery, and lead to progressive intraoperative pupil constriction.
The loss of iris dilatator muscle tone, which does not affect a person’s vision, but is associated with a higher risk of cataract surgical complications such as iris, trauma and lens capsule tears.
The incidence of IFIS is currently approximately 1% among cataract operations.
Asssociated with tamsulosin, a medication prescribed for urinary symptoms associated with benign prostatic hyperplasia.
Severe IFIS is most commonly seen with selective alpha-one antagonists such as tamsulosin and silodosin
Tamsulosin is a selective alpha blocker that works by relaxing the bladder and prostatic smooth muscle, and relaxes the iris dilator muscle by binding to its postsynaptic nerve endings.
Any tamsulosin exposure can cause IFIS during cataract extraction indefinitely, and the severity of the condition is not linked to the duration of tamsulosin intake.
IFIS is also associated with finasteride.
IFIS does not usually cause significant changes in postoperative cataract outcomes, but patients may have more pain, a longer recovery period, and less improvement in visual acuity than a patient with an uncomplicated cataract removal.
Use of atropine drops or epinephrine dilution can be considered as prophylaxis prior to surgery.
Other non-pharmacologic interventions may be used during the procedure to reduce the risk of IFIS-including triplanar corneal incisions, trypan blue, less aggressive irrigation and aspiration, iris retractors, and refractor rings.