Topical atropine and NSAIDs before cataract surgery may reduce IFIS risk
Israel: Preoperative administration of topical atropine 1% and non-steroidal anti-inflammatory drugs (NSAIDs) before cataract surgery may prevent intraoperative floppy iris syndrome (IFIS), says a recent study. The study appears in Graefe's Archive for Clinical and Experimental Ophthalmology.
The study was conducted by Margarita Safir, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, and colleagues with an objective to examine the efficacy of preoperative administration of topical atropine 1% and NSAIDs for the prevention of intraoperative floppy iris syndrome in a retrospective cohort study.
The study included patients who underwent cataract surgery by phacoemulsification between July 2019 and February 2020 in two hospitals in Israel having similar patient demographics and similar surgical techniques. However, they differ in policy of IFIS prevention.
In Meir Medical Center no preventive medications are given pre-operatively, while in Shamir Medical Center patients at risk for IFIS receive topical atropine 1% once daily and non-steroidal anti-inflammatory drugs (NSAIDs) thrice daily for 3 days preoperatively.
Overall, the study included 207 eyes of 207 patients with a history of alpha-antagonist use. Mean age was 74.9 ± 7.8 years and 82.1% (n = 170) were male.
The study revealed the following findings:
- Among patients from the pretreating center, 86.8% (n = 92/106) were pre-treated with either NSAIDs or atropine preoperatively, while in the non-pretreating center no treatment was prescribed (n = 0/101).
- IFIS rate among the non-pretreating center was 29.7% (n = 30/101) compared to 15.1% (n = 16/106) in the pretreating center.
- When strictly comparing treated to untreated patients, the treated group had an IFIS rate of 12.0% compared to 30.4% among the untreated.
- Adjusted for age and gender results remain consistent (odds ratio 0.329 for treated patients).
The findings led to the conclusion that IFIS rates were significantly lower in the pretreating center versus the non-pretreating center. Differences were even more pronounced when comparing strictly treated to untreated patients.
Reference:
Sharon, T., Hecht, I., Atar Vardi, M. et al. Preoperative atropine and non-steroidal anti-inflammatory drugs for the prevention of intraoperative floppy iris syndrome. Graefes Arch Clin Exp Ophthalmol 260, 893–900 (2022). https://doi.org/10.1007/s00417-021-05444-1
