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IFIS – Intraoperative Floppy-Iris Syndrome Fritz Allen 10-2010
IFIS ,[object Object]
ASCRS  White Paper JCRS 12/08
IFIS ,[object Object],[object Object],[object Object],[object Object]
IFIS-Surgical Complications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Email from 5/5/09 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
IFIS ,[object Object],[object Object]
BPH- Benign Prostatic  Hyperplasia Incidence ,[object Object],[object Object],[object Object]
Tamsulosin (Flomax)  ,[object Object],[object Object],[object Object],[object Object]
Alpha 1 antagonists ,[object Object],[object Object],[object Object],[object Object],[object Object]
IFIS ,[object Object],[object Object]
IFIS ,[object Object]
The Effect of the  α 1 -Adrenergic Receptor Antagonist  Tamsulosin (Flomax) on Iris Dilator Muscle Anatomy Ricardo Santaella, MD, John Destafeno, MD, Sara Miller, PhD, Sandra Stinnett, DrPH, Alan Proia, MD, Terry Kim, MD Albert Eye Research Institute Duke University Medical Center Durham, North Carolina
Control Subject Tamsulosin Subject Light Microscopy Morphometric Results  Representative sample photomicrographs  *  Indicates iris dilator smooth muscle. (H&E) Mean  (micrometers) Tamsulosin group n=26  Control Group n=26  P-Value* Iris Dilator Muscle Thickness 6.62  (SD=2.22) 8.20   (SD=1.77) 0.004 Iris Stromal Thickness 275.98 (SD=68.17) 274.65 (SD=57.96) 0.925
Other BPH drugs ,[object Object],[object Object],[object Object],[object Object]
IFIS Management  Strategies ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
IFIS ,[object Object]
Pharmacologic ,[object Object],[object Object],[object Object],[object Object]
Intraoperative Techniques ,[object Object],[object Object],[object Object],[object Object]
Mechanical Pupil Expansion Devices ,[object Object],[object Object]
IFIS  ,[object Object]
ASCRS IFIS Survey 3/08 Chang DF, et al; Cataract Clinical Committee  J Cataract Refract Surg (July) 2008; 34: 1201-1209 ,[object Object],[object Object],[object Object]
IFIS - 2009  Unanswered ?’s ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
epi hooks H 5 atropine Multiple strategies Rings Other Favorite  initial  strategy  for IFIS
18%  more difficult, same risk 65%  more difficult, >risk 5%  “ No different” Surgical difficulty  with tamsulosin 13%  very difficult, >risk 95%  “ More Difficult” 5%  77%  “ Greater Risk”
23%  >PC Rupture 52%  > iris trauma 30%
Would you take tamsulosin ? (mild cataract) ,[object Object],[object Object],[object Object],[object Object]
What do Ophthalmologists really think? ,[object Object],[object Object]
Routine referral pre-tamsulosin? 41% “NO”   38% “ IF HX  OR  CATARACT”  21% “ ROUTINELY”   VA Other   α -blockers   58%  “NO” 11%  “ROUTINELY” 31%  “IF HX CAT”
More education for prescribing MD? 91% Agree 3% Disagree
Prescribing MD Education ,[object Object],[object Object],[object Object],[object Object]
MAS Ophthalmology Experience  ,[object Object],[object Object],[object Object],[object Object]
MAS  ,[object Object],[object Object],[object Object]
Ophthalmology and Urology Working Together ,[object Object],[object Object],[object Object],[object Object]

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Ifis intraoperative_floppy-iris_syndrome (reviewed)

  • 1. IFIS – Intraoperative Floppy-Iris Syndrome Fritz Allen 10-2010
  • 2.
  • 3. ASCRS White Paper JCRS 12/08
  • 4.
  • 5.
  • 6.
  • 7.
  • 8.
  • 9.
  • 10.
  • 11.
  • 12.
  • 13. The Effect of the α 1 -Adrenergic Receptor Antagonist Tamsulosin (Flomax) on Iris Dilator Muscle Anatomy Ricardo Santaella, MD, John Destafeno, MD, Sara Miller, PhD, Sandra Stinnett, DrPH, Alan Proia, MD, Terry Kim, MD Albert Eye Research Institute Duke University Medical Center Durham, North Carolina
  • 14. Control Subject Tamsulosin Subject Light Microscopy Morphometric Results Representative sample photomicrographs * Indicates iris dilator smooth muscle. (H&E) Mean (micrometers) Tamsulosin group n=26 Control Group n=26 P-Value* Iris Dilator Muscle Thickness 6.62 (SD=2.22) 8.20 (SD=1.77) 0.004 Iris Stromal Thickness 275.98 (SD=68.17) 274.65 (SD=57.96) 0.925
  • 15.
  • 16.
  • 17.
  • 18.
  • 19.
  • 20.
  • 21.
  • 22.
  • 23.
  • 24. epi hooks H 5 atropine Multiple strategies Rings Other Favorite initial strategy for IFIS
  • 25. 18% more difficult, same risk 65% more difficult, >risk 5% “ No different” Surgical difficulty with tamsulosin 13% very difficult, >risk 95% “ More Difficult” 5% 77% “ Greater Risk”
  • 26. 23% >PC Rupture 52% > iris trauma 30%
  • 27.
  • 28.
  • 29. Routine referral pre-tamsulosin? 41% “NO” 38% “ IF HX OR CATARACT” 21% “ ROUTINELY” VA Other α -blockers 58% “NO” 11% “ROUTINELY” 31% “IF HX CAT”
  • 30. More education for prescribing MD? 91% Agree 3% Disagree
  • 31.
  • 32.
  • 33.
  • 34.