Pediatric intraoperative floppy iris syndrome associated with persistent pupillary membrane

Area of Science:

• Ophthalmology
• Pediatric Ophthalmology
• Surgical Complications

Background:

• Intraoperative floppy iris syndrome (IFIS) is a known complication during cataract surgery in adults, often associated with alpha-1(a) adrenergic antagonists like tamsulosin.
• Pediatric IFIS is exceptionally rare, with only one prior reported case linked to congenital cataracts.

Observation:

• A 1-month-old infant presented with IFIS during cataract surgery.
• The infant had bilateral persistent pupillary membranes but no cataracts.
• Preoperative topical phenylephrine and pilocarpine were administered for IFIS prophylaxis.

Findings:

• This case represents a novel occurrence of IFIS in a pediatric patient without cataracts.
• The syndrome was observed in conjunction with bilateral persistent pupillary membranes.
• The use of prophylactic topical phenylephrine and pilocarpine did not prevent IFIS in this infant.

Implications:

• This report expands the understanding of IFIS in pediatric populations, suggesting pupillary abnormalities may be a risk factor.
• It questions the efficacy of standard IFIS prophylactic measures in certain pediatric cases.
• Further research is needed to elucidate the specific mechanisms and risk factors for IFIS in infants.