Alpha-blockers and intraoperative floppy iris syndrome: ophthalmic adverse events following cataract surgery

Intraoperative floppy iris syndrome (IFIS) is a triad of progressive intraoperative miosis despite preoperative dilation, billowing of a flaccid iris, and iris prolapse toward the incision sites during phacoemulsification surgery for cataract removal. IFIS has been associated with systemic alpha(1)-adrenergic receptor antagonists and other classes of medications for benign prostatic hyperplasia, as well as other systemic disease. The condition is best managed with several surgical and pharmacologic options if anticipated prior to surgery. Such precautions result in excellent surgical and visual acuity outcomes that appear similar to non-IFIS-affected eyes. There is still much to learn about IFIS and its exact causes, as well as a need for agreed upon guidelines that would enable physicians to properly anticipate and successfully manage or even prevent the condition.