Review and Update of Intraoperative Floppy Iris Syndrome

Ahmed Sallam; Hany El-Defrawy; Adam Ross; Samer J Bashir; Hamish MA Towler


Expert Rev Ophthalmol. 2011;6(4):469-476. 

In This Article

Five-year View

Since its description by Chang and Campbell in 2005,[9] there have been in excess of 100 reports published regarding IFIS. While our knowledge and awareness of the etiology and management of IFIS have significantly improved,[18,19,33–37] there are still certain aspects of this condition that need to be explored further and could impact future treatment strategies of IFIS within the next 5 years.

The exact pathophysiology of IFIS and the effect of tamsulosin on iris mechanics are not completely understood. We know that the occurrence of IFIS with this class of drugs is mainly based on pharmacological blockade of the α1-adrenergic receptors present in the iris.[28–30] However, there is insufficient evidence to explain why this blockade is permanent and whether this is due to disuse atrophy of the dilator muscle,[29,32] vascular dysfunction[30] and/or iris denervation. It is reasonable to suggest that future focus should be directed at the localization of the α-1 adrenergic receptors in the iris as well as the histology of the human iris in tamsulosin patients.

There are no published trials to inform the most appropriate method for managing IFIS. Randomized prospective trials are needed to compare the safety and efficacy of the different management modalities of IFIS, particularly as our experience with the use of intracameral α-1 agonists, a strategy of growing popularity in our armamentarium for managing IFIS, is mainly based on a few uncontrolled small series and case reports.[34–37]