Predictive value of pupillography on intraoperative floppy iris syndrome in preoperative period

AIM: To present the frequency of intraoperative floppy iris syndrome(IFIS) in cataract patients who taking alpha 1-a receptor antagonist(ARA) drugs, and evaluate the predictive value of pupil diameter(PD) changes in IFIS patients.METHODS: Male cataract patients who are under treatment with alpha-1 a-ARAs(alfuzosin, tamsulosin) intraoperatively were evaluated and were grouped as with/without IFIS. The preoperative PD values were compared with controls. Also, the intraoperative manipulations and early/late complications were recorded.RESULTS: A total of 77 patients(77 eyes) of 94 benign prostate hyperplasia(BPH) patients have been defined as IFIS(81.91%) and 40 patients(40 eyes) were taking tamsulosin and 37 patients(37 eyes) were taking alfuzosin. During the cataract surgery, the rate of posterior capsular rupture(P=0.754), vitreous loss(P=0.585), iris tears(P=0.004), and iris catching(P=0.000) were higher in IFIS group, but the difference was significant only in the iris catching. At the postoperative first-month visit, persistent IOP rise and iris stromal tears were more frequent in IFIS group, but the difference was not significant(P=0.311, P=0.146;respectively). In contrast, Descemet membrane detachment was insignificantly more frequent in controls(P=0.311). In IFIS and control patients, PDs were 9.54±1.78 and 9.72±1.57 mm(P=0.255) under scotopic illumination, 8.54±1.43 and 8.74±1.25 mm(P=0.289) under mesopic illumination, 6.99±1.35 and 7.27±1.39 mm(P=0.662) under photopic illumination, respectively. However PDs were lower in IFIS under all illumination degrees, no significant difference was detected between groups.CONCLUSION: IFIS is a significant clinical syndrome with an increased intraoperative/postoperative complication ratio. The prediction of this syndrome is important because of prevention required precautions against possible complications. There is no association between IFIS and preoperative PD.

Efficacy of custom-made soft keratoconus lenses on corneal aberrations and photic phenomena in patients with keratoconus:a corneal topography imaging based study

AIM:To evaluate the efficacy of custom-made soft keratoconus(KC)lenses on corneal aberrations and photic phenomena in two different optical zones in patients with KC.METHODS:Sixty eyes of 42 patients with KC were examined at baseline and after fitting HydroCone(Toris K)soft silicone hydrogel lenses.Best spectacle-corrected visual acuity(BSCVA)and contact lens-corrected visual acuity(CLCVA)were recorded.Lower-and higher-order corneal aberrations(LOAs and HOAs)were measured with and without Toris K lenses and compared in central 4.5 mm and 7 mm zones.Mesopic pupil diameter and subjective photic phenomena were also assessed.RESULTS:Mean CLCVA was significantly improved compared to BSCVA(P<0.0001).Corneal curvature and refractive measurements were found to be significantly reduced by the use of Toris K lenses,except for posterior corneal curvature values.In the 4.5 mm central optical zone,all wavefront aberrations decreased significantly after lens fitting(P<0.0001).In contrast,in the 7 mm(peripheral)optical zone,values for HOAs,spherical and residual aberrations,and optical path differences were increased,while LOAs,trefoil,and quadrifoil coefficients were decreased.The rate of photic phenomena was significantly higher in participants with a pupil size>6.00 mm(85.7%).CONCLUSION:Toris K lenses provide good visual results and a significant reduction in central corneal aberrations in patients with KC but could cause an increase in peripheral aberrations.This practical and nonsurgical approach appears to be an effective method for the visual management of KC.