Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. X:X | DOI: 10.5507/bp.2025.025

Comparing the efficiency of two prophylactic approaches in patients at risk of developing Intraoperative Floppy Iris Syndrome

Miroslava Maluskova^{1, 2}, Klara Maresova^{1, 2}, Zuzana Schreiberova^{1, 2}, Barbora Paskova^{1, 2}, Marta Karhanova^{1, 2}

¹ Department of Ophthalmology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic

² Department of Ophthalmology, University Hospital Olomouc, Olomouc, Czech Republic

Background and Aims: Intraoperative Floppy Iris Syndrome (IFIS) is a condition that can lead to a number of complications during cataract surgery that threaten final vision of patients using alpha1-adrenergic receptor antagonists (α1-ARAs). There are two recommended pharmacological approaches to preventing IFIS development: intraoperative intracameral epinephrine and application of atropine drops twice a day for one week before surgery. The primary aim of this study was to identify the incidence and grade of IFIS using these two prophylactic approaches in patients at risk of IFIS development and to determine which approach is more effective for mild and severe IFIS. The second aim was to evaluate complication rates between the two.

Methods: The study consisted of 164 eyes of 164 men using α1-ARAs. 83 eyes were treated with atropine sulphate 1% drops (Group 1) while 81 eyes received an injection of epinephrine to the anterior chamber during cataract surgery (Group 2).

Results: Even though the incidence of IFIS was lower in the epinephrine group this was not statistically significant at the 5% level (P=0.269). Apropos severity, there was a statistically significantly higher incidence of moderate and severe forms of IFIS in Group 2 (P<0.0001). There was no significant difference between groups in the development of surgical complications (P=0.165).

Conclusions: The instillation of epinephrine was more effective in preventing the overall incidence of IFIS. Nevertheless, the occurrence of IFIS in its moderate and severe forms was statistically significantly higher in this group.

Trial registration. The study protocol was retrospectively registered in the Clinical Trial registry clinicaltrials.gov under ID number NCT06266962

Keywords: IFIS, epinephrine, atropine, α1-ARAs

Received: March 9, 2025; Revised: July 9, 2025; Accepted: September 2, 2025; Prepublished online: September 19, 2025