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Preoperative atropine and non-steroidal anti-inflammatory drugs for the prevention of intraoperative floppy iris syndrome

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Abstract

Purpose

To examine the efficacy of preoperative administration of topical atropine 1% and non-steroidal anti-inflammatory drugs (NSAIDs) for prevention of intraoperative floppy iris syndrome (IFIS).

Methods

In this retrospective cohort study, patients who underwent cataract surgery by phacoemulsification between July 2019 and February 2020 in two hospitals were included. Both hospitals are located in central Israel, have similar patient demographics and employ similar surgical techniques. They, however, 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.

Results

Overall, 207 eyes of 207 patients with history of alpha-antagonist use were included. Mean age was 74.9 ± 7.8 years and 82.1% (n = 170) were male. 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 (p = 0.012). When strictly comparing treated to untreated patients, the treated group had an IFIS rate of 12.0% compared to 30.4% among untreated (p = 0.001). Adjusted for age and gender results remain consistent (odds ratio 0.329 for treated patients, 95% confidence interval: 0.150–0.720; p = 0.005).

Conclusions

IFIS rates were significantly lower in the pretreating center compared to the non-pretreating center. When comparing strictly treated to untreated patients, differences were even more pronounced.

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Authors and Affiliations

  1. Ophthalmology Department, Meir Medical Center, Kefar Sava, Israel

    Tal Sharon & Ehud I. Assia

  2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Tal Sharon, Idan Hecht, Maya Atar Vardi, Ron Eremenko, Ehud I. Assia, Eran Pras & Margarita Safir

  3. Ophthalmology Department, Shamir Medical Center, 70300, Zerifin, Israel

    Idan Hecht, Maya Atar Vardi, Ron Eremenko, Eran Pras & Margarita Safir

  4. Ein-Tal Eye Center, Tel Aviv, Israel

    Ehud I. Assia

Authors
  1. Tal Sharon
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  2. Idan Hecht
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  3. Maya Atar Vardi
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  4. Ron Eremenko
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  5. Ehud I. Assia
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  6. Eran Pras
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  7. Margarita Safir
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Contributions

T.S conceived the project and wrote the manuscript. I.H performed statistical analysis and critically revised the manuscript. M.V and R.E collected data. E.P and E.A: Contributed to the discussion and critically revised the manuscript. M.S: conceived the project, wrote the manuscript and directed the project. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Margarita Safir.

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Ethics approval and consent to participate

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Shamir Medical Center IRB and Meir Medical Center IRB and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Due to the retrospective nature of the study a waiver of informed consent was granted. This article does not contain any studies with animals performed by any of the authors.

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The authors declare that they have no conflict of interests.

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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

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  • DOI: https://doi.org/10.1007/s00417-021-05444-1

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