超声乳化白内障吸除术中虹膜松弛综合征的研究进展

Clinical research of intraoperative floppy iris syndrome during operation

超声乳化白内障吸除术中虹膜松弛综合征（IFIS）是一种新的小瞳孔综合征，其特征为：松软的虹膜基质随正常的灌注流量而起伏、涌动；虹膜易突出并嵌顿于水密的切口；虽经术前充分的药物散瞳仍出现的术中进行性瞳孔缩小。目前多数学者认为术中虹膜松弛综合征与服用一种治疗慢性前列腺增生的高选择性肾上腺素α-1受体拮抗剂坦索洛辛有关。建议白内障术前应仔细询问患者有无服用坦索洛辛等α-1受体拮抗剂药物史，以预见术中IFIS。术前可采用1％阿托品扩瞳，必要时术中可前房注射苯肾上腺素或肾上腺素稀释液；使用高黏性2．3％透明质酸钠（Healon5）的软壳一超软壳技术；采用低灌注（20—25ml／min）或低吸力（≤250mmHg，1mmHg=0．133kPa）；并根据情况应用虹膜拉钩或瞳孔扩张环等，有助于减少手术并发症。

Intraoperative floppy iris syndrome （IFIS） has been recently identified as a new small pupil syndrome during phacoemulsification. This syndrome is characterized by three intraoperative features：a flaccid iris stroma that undulates and billows in response to intraocular fluid currents;a propensity for the floppy iris stroma to prolapse toward the tip of phacoemulsification and side-port incisions despite proper wound construction; and progressive intraoperative pupil constriction despite standard preventive preoperative pharmacologic measures designed to prevent this. It is now mostly considered that IFIS is associated with the use of tamsolusin, a highly selective α-1A receptor antagonist for the treatment of benign prostatic hypertrophy. It is recommended that a careful history of the use of α-1 blocking agents be taken before cataract surgery to anticipate the occurrence of IFIS. A combination of strategies could decrease the complications of IFIS. These procedures include preoperative use of atropine, intracameral injection of dilute phenylephrine or epinephrine, the use of super-cohesive ophthalmic viscosurgical devices, lower phacoemulsification vacuum and aspiration settings and various iris hooks or pupil dilators.