Intraoperative floppy iris syndrome in cataract surgery: effects of opium use

This study aims to identify risk factors associated with IFIS in patients undergoing phacoemulsification at a tertiary care center.

A prospective cohort study involved 1722 patients aged 40-90 years underwent phacoemulsification with implantation of an intraocular lens (IOL) into the posterior chamber was conducted from March 2024 to April 2025. Exclusion criteria included a history of ocular surgery, trauma, or advanced ocular diseases. Demographic data, ocular parameters, comorbidities, and medication use were collected. The severity of IFIS was graded intraoperatively using the Chang and Campbell criteria. A bivariable and multivariable logistic regression was utilized.

IFIS occurred in 223 patients (cumulative incidence: 13.0%; 95% confidence intervals (CI): 11.4-14.6). Multivariable analysis identified significant risk factors: alpha-blocker use (Adjusted odds ratio (AOR)=11.3; 95%CI: 6.1-20.7), pseudoexfoliation syndrome (AOR=1.88; 95%CI: 1.1-3.02), and opium use of 10 years or more (AOR=1.79; 95%CI: 1.1-2.7). Increasing age was also independently associated with IFIS (AOR=1.01; 95% CI: 1.00-1.02).

Increasing age, shorter axial length, smaller pupil size, alpha-blockers, pseudoexfoliation syndrome, and long-term opium use (≥ 10 years) are key predictors of IFIS. A clear dose-response relationship was observed with opium duration, where use for 10 years or more significantly increased the risk, while shorter use did not. A comprehensive review of medication and opium use history is essential for mitigating surgical complications.