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中华眼科医学杂志(电子版) ›› 2023, Vol. 13 ›› Issue (01) : 1 -5. doi: 10.3877/cma.j.issn.2095-2007.2023.01.001

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重视虹膜松弛综合征围手术期的防治
刘兆川, 宋旭东†()   
  1. 100730　首都医科大学附属北京同仁医院　北京同仁眼科中心　北京市眼科研究所　北京市眼科学与视觉科学重点实验室
  • 收稿日期:2022-01-09 出版日期:2023-02-28
  • 通信作者: 宋旭东
  • 基金资助:
    国家自然科学基金项目(82271067); 北京市优秀人才青年骨干个人项目(2018000021469G208)

Pay attention to the perioperative prevention and treatment of floppy iris syndrome

Zhaochuan Liu, Xudong Song†()   

  1. Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Institute of Ophthalmology, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing 100730, China
  • Received:2022-01-09 Published:2023-02-28
  • Corresponding author: Xudong Song
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刘兆川, 宋旭东. 重视虹膜松弛综合征围手术期的防治[J]. 中华眼科医学杂志(电子版), 2023, 13(01): 1-5.

Zhaochuan Liu, Xudong Song. Pay attention to the perioperative prevention and treatment of floppy iris syndrome[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2023, 13(01): 1-5.

虹膜松弛综合征常见于长期服用α－1受体拮抗剂的患者，是一种在超声乳化白内障手术过程中出现的并发症，其特征性表现为术中虹膜脱垂、瞳孔渐进性缩小和虹膜浪涌的三联征。虹膜松弛综合征可显著增加手术风险，易导致后囊破裂、玻璃体疝、皮质残留和虹膜损伤等一系列严重影响患者视力恢复的并发症。因此，虹膜松弛综合征围手术期的防治受到眼科学者们的广泛关注。本文中笔者就虹膜松弛综合征的临床特点和围手术期的防治进行评述。

关键词: 虹膜松弛综合征, 超声乳化白内障吸除术, 肾上腺素能α－1受体拮抗剂, 坦索罗辛, 瞳孔扩张器, 虹膜拉钩

Floppy iris syndrome (FIS) is a complication during cataract surgery in patients with a history of using of α-1 adrenoreceptor antagonist before surgery. FIS is characterized by a triad of iris prolapse, progressive intraoperative miosis, and billowing of the iris. The occurrence of FIS is associated with sight-threatening complications such as posterior capsule rupture, vitreous loss, nuclear fragments residue and iris trauma. Thus, perioperative prevention and treatment of FIS has been paid intense attention by ophthalmologists. The clinical characteristics, perioperative prevention and management of FIS was summarized in this paper.

Key words: Floppy iris syndrome, Phacoemulsification cataract extraction, Adrenoceptor α-1 antagonist, Tamsolusin, Pupil dilator, Iris retractor
表1 已报道虹膜松弛综合征相关药物
药物类别 药物名称 作者 报道年份
α受体阻滞剂 坦索罗辛(tamsulosin) Chang 2005
  哌咗嗪(prazosin) Issa 2008
  多沙咗嗪(doxazosin) Panagis 2010
  阿夫唑嗪片(alfuzosin) Chatziralli 2012
  特拉唑嗪(terazosin) Chatziralli 2012
  利血平(reserpine) 姚克 2017
α、β受体阻滞剂 拉贝洛尔(labetalol) Calotti 2007
抗精神病药物 珠氯噻醇(zuclopentixol) Pringle 2005
  米安色林(mianserin) Ugarte 2007
  利司培酮(risperidon) Ford 2009
  苯二氮卓(benzodiazepine) Chatziralli 2012
  丙咪嗪(imipramine) Gupta 2012
  喹硫平(quetiapine) Chatziralli 2016
5α还原酶抑制剂 非那雄胺(finasteride) Wong AC 2010
表2 常用瞳孔扩张器类型
名称 厂家 特点
Assia (APX) 200瞳孔扩张器 APX Ophthalmology Ltd. 一次性使用，无推注装置
Bhattacharjee瞳孔扩张环 Madhu Instruments 一次性使用，需23－G锯齿镊植入；分为矩形和六边形两种
Bhattacharjee第三代瞳孔扩张环 Med Invent Devices 一次性使用，需23－G锯齿镊植入
Canabrava环 AJL Ophthalmic 一次性使用，需McPherson镊植入
Graether 2000瞳孔扩张器 Katena Products，Inc. 一次性使用，预装式，附带滑行式虹膜拉钩
I－Ring瞳孔扩张器 Beaver－Visitec International 一次性使用，预装式
Malyugin环1.0型 MicroSurgical Technology 一次性使用，专用注入器2.2 mm切口植入
Malyugin环2.0型 MicroSurgical Technology 一次性使用，专用注入器2.2 mm切口植入，6.25 mm和7.0 mm两种直径
Morcher MR－5S瞳孔扩张器 FCI Ophthalmics 一次性使用，可使用Geuder推注器
OASIS虹膜扩张器 Oasis Medical Inc. 一次性使用，可使用推注器，6.25 mm和7.0 mm两种直径
Perfect瞳孔扩张器 Milvella limited 一次性使用，可使用推注器
Xpand NT Diamatrix LTD 通过2.5 mm主切口植入
[1]
Chang DF, Campbell JR. Intraoperative floppy iris syndrome associated with tamsulosin[J]. J Cataract Refract Surg, 2005, 31(4): 664－673.
[2]
Bell CM, Hatch WV, Fischer HD, et al. Association between tamsulosin and serious ophthalmic adverse events in older men following cataract surgery[J]. JAMA, 2009, 301(19): 1991－1996.
[3]
Arshinoff SA. Modified SST－USST for tamsulosin－associated intraocular floppy－iris syndrome[J]. J Cataract Refract Surg, 2006, 32(4): 559－561.
[4]
Ozcura F, Irgat SG. Bilateral Intraoperative Floppy Iris Syndrome Associated with Silodosin Intake[J]. Eurasian J Med, 2020, 52(1): 100－102.
[5]
Yang X, Liu Z, Fan Z, et al. A narrative review of intraoperative floppy iris syndrome: an update 2020[J]. Ann Transl Med, 2020, 8(22): 1546.
[6]
Alio JL. Cataract Surgery: From Today′s Standards to Future Progress[J]. Asia Pac J Ophthalmol (Phila), 2017, 6(4): 309.
[7]
Schwinn DA, Afshari NA. α1－Adrenergic Receptor Antagonists and the Iris: New Mechanistic Insights into Floppy Iris Syndrome[J]. Survey of Ophthalmology, 2006, 51(5): 501－512.
[8]
姚克. 关注白内障手术中的虹膜松弛综合征[J]. 中华眼科杂志，2012, 48(4): 289－291.
[9]
Friedman, Alan H. Tamsulosin and the Intraoperative Floppy Iris Syndrome[J]. Jama, 2009, 301(19): 2044－2045.
[10]
Wahl M, Tipotsch－Maca SM, Vecsei－Marlovits PV. Intraoperative floppy iris syndrome and its association with various concurrent medications, bulbus length, patient age and gender[J]. Graefes Arch Clin Exp Ophthalmol, 2017, 255(1): 113－118.
[11]
Lim DH, Lee MG, Chung TY, et al. Korean patients taking alpha1－adrenergic receptor antagonists show lower incidence of intraoperative floppy iris syndrome than western patients[J]. Br J Ophthalmol, 2014, 98(4): 479－483.
[12]
俞捷心，姚克. 白内障超声乳化术中虹膜松弛综合征发生的新危险因素和预测指标[J]. 国际眼科杂志，2017, 17(11): 2126－2129.
[13]
Wilson MJ, Trivedi RH, Mistr S. Pediatric intraoperative floppy－iris syndrome[J]. J Cataract Refract Surg, 2007, 33(7): 1325－1327.
[14]
Chatziralli IP, Peponis V, Parikakis E, et al. Risk factors for intraoperative floppy iris syndrome: a prospective study[J]. Eye (Lond), 2016, 30(8): 1039－1044.
[15]
Issa SA, Dagres E. Intraoperative floppy－iris syndrome and finasteride intake[J]. J Cataract Refract Surg, 2007, 33(12): 2142－2143.
[16]
Kaczmarek IA, Prost ME, Wasyluk J. Clinical risk factors associated with intraoperative floppy iris syndrome: a prospective study[J]. Int Ophthalmol, 2019, 39(3): 541－549.
[17]
Tzamalis A, Malyugin B, Ziakas N, et al. Angiotensin receptor inhibitors as main predisposing factor for intraoperative floppy iris syndrome in women[J]. J Cataract Refract Surg, 2019, 45(5): 696－697.
[18]
Tzamalis A, Matsou A, Dermenoudi M, et al. The role of sex in intraoperative floppy－iris syndrome[J]. J Cataract Refract Surg, 2019, 45(1): 41－47.
[19]
Chen AA, Kelly JP, Bhandari A, et al. Pharmacologic prophylaxis and risk factors for intraoperative floppy－iris syndrome in phacoemulsification performed by resident physicians[J]. J Cataract Refract Surg, 2010, 36(6): 898－905.
[20]
Christou CD, Tsinopoulos I, Ziakas N, et al. Intraoperative Floppy Iris Syndrome: Updated Perspectives[J]. Clin Ophthalmol, 2020, 14：463－471.
[21]
Perumal C, Chowdhury PS, Ananthakrishnan N, et al. A comparison of the efficacy of naftopidil and tamsulosin hydrochloride in medical treatment of benign prostatic enlargement[J]. Urol Ann, 2015, 7(1): 74－78.
[22]
Schwinn DA, Roehrborn CG. Alpha1－adrenoceptor subtypes and lower urinary tract symptoms[J]. Int J Urol, 2008, 15(3): 193－199.
[23]
Keklikci U, Isen K, Unlu K, et al. Incidence, clinical findings and management of intraoperative floppy iris syndrome associated with tamsulosin[J]. Acta Ophthalmol, 2009, 87(3): 306－309.
[24]
Lunacek A, Mohamad AB, Radmayr C, et al. Ten years of intraoperative floppy iris syndrome in the era of alpha－blockers[J]. Cent European J Urol, 2018, 71(1): 98－104.
[25]
Goseki T, Ishikawa H, Ogasawara S, et al. Effects of tamsulosin and silodosin on isolated albino and pigmented rabbit iris dilators: Possible mechanism of intraoperative floppy－iris syndrome[J]. J Cataract Refract Surg, 2012, 38(9): 1643－1649.
[26]
Zaman F, Bach C, Junaid I, et al. The floppy iris syndrome － what urologists and ophthalmologists need to know[J]. Curr Urol, 2012, 6(1): 1－7.
[27]
Nuzzi R, Arnoffi P, Tridico F. Best Prophylactic Strategy in Groups at Risk of Intraoperative Floppy Iris Syndrome Development: Comparison Between Atropine Instillation and Adrenaline Intracameral Injection[J]. Open Ophthalmol J, 2018, 12：34－40.
[28]
Aktas Z, Yuksel N, Ceylan G, et al. The effects of tamsulosin and alfuzosin on iris morphology: an ultrasound biomicroscopic comparison[J]. Cutan Ocul Toxicol, 2015, 34(1): 38－41.
[29]
Chang DF, Campbell JR, Colin J, et al. Prospective Masked Comparison of Intraoperative Floppy Iris Syndrome Severity with Tamsulosin versus Alfuzosin[J]. Ophthalmology, 2014, 121(4): 829－834.
[30]
Dogan M, Kutluksaman B, Keles I, et al. The Effects of Systemic Alfuzosin and Tamsulosin Hydrochloride on Choroidal Thickness and Pupil Diameter Sizes in Cases with Benign Prostatic Hyperplasia[J]. Curr Eye Res, 2017, 42(12): 1638－1643.
[31]
Chatterjee S, Agrawal D. Silodosin－associated intraoperative floppy iris syndrome[J]. Indian J Ophthalmol, 2017, 65(6): 538－539.
[32]
Ozcura F, Irgat SG. Bilateral Intraoperative Floppy Iris Syndrome Associated with Silodosin Intake[J]. Eurasian J Med, 2020, 52(1): 100－102.
[33]
Wong AC, Mak ST. Finasteride－associated cataract and intraoperative floppy－iris syndrome[J]. J Cataract Refract Surg, 2011, 37(7): 1351－1354.
[34]
Pringle E, Packard R. Antipsychotic agent as an etiologic agent of IFIS[J]. J Cataract Refract Surg, 2005, 31(12): 2240－2241.
[35]
Unal M, Yucel I, Tenlik A. Intraoperative floppy－iris syndrome associated with chronic use of chlorpromazine[J]. Eye (Lond), 2007, 21(9): 1241－1242.
[36]
Matsuo M, Sano I, Ikeda Y, et al. Intraoperative floppy－iris syndrome associated with use of antipsychotic drugs[J]. Canadian Journal of Ophthalmology, 2016, 51(4): 294－296.
[37]
Gonzalez－Martin－Moro J, Gonzalez－Lopez JJ, Zarallo－Gallardo J, et al. Intraoperative floppy iris syndrome after treatment with duloxetine: coincidence, association, or causality？[J]. Arch Soc Esp Oftalmol, 2015, 90(2): 94－96.
[38]
Papadopoulos R, Bachariou A. Intraoperative floppy－iris syndrome associated with chronic intake of donepezil[J]. J Cataract Refract Surg, 2007, 33(11): 1997－1998.
[39]
Neff KD, Sandoval HP, Fernández De Castro LE, et al. Factors Associated with Intraoperative Floppy Iris Syndrome[J]. Ophthalmology, 2009, 116(4): 658－663.
[40]
Enright JM, Karacal H, Tsai LM. Floppy iris syndrome and cataract surgery[J]. Curr Opin Ophthalmol, 2017, 28(1): 29－34.
[41]
Altan－Yaycioglu R, Gedik S, Pelit A, et al. Clinical factors associated with floppy iris signs: a prospective study from two centers[J]. Ophthalmic Surg Lasers Imaging, 2009, 40(3): 232－238.
[42]
Casuccio A, Cillino G, Pavone C, et al. Pharmacologic pupil dilation as a predictive test for the risk for intraoperative floppy－iris syndrome[J]. J Cataract Refract Surg, 2011, 37(8): 1447－1454.
[43]
Terauchi Y, Horiguchi H, Shiba T. The Pharmacological Mydriatic Pupil－to－Limbal Diameter Ratio as an Intuitive Predictor for the Risk of Intraoperative Floppy Iris Syndrome[J]. J Ophthalmol, 2018: 2837934.
[44]
Esen F, Bulut AE, Toker E. Efficacy and safety of low－concentration, bisulphite－containing, intracameral epinephrine and topical atropine treatments for the prevention of intraoperative floppy iris syndrome[J]. Cutan Ocul Toxicol, 2018, 37(3): 286－290.
[45]
Nuzzi R, Arnoffi P, Tridico F. Best Prophylactic Strategy in Groups at Risk of Intraoperative Floppy Iris Syndrome Development: Comparison Between Atropine Instillation and Adrenaline Intracameral Injection[J]. Open Ophthalmol J, 2018, 12：34－40.
[46]
Bendel RE, Phillips MB. Preoperative use of atropine to prevent intraoperative floppy－iris syndrome in patients taking tamsulosin[J]. J Cataract Refract Surg, 2006, 32(10): 1603－1605.
[47]
Visco D. Effect of phenylephrine/ketorolac on iris fixation ring use and surgical times in patients at risk of intraoperative miosis[J]. Clin Ophthalmol, 2018, 12：301－305.
[48]
Lunacek A, Mohamad AB, Radmayr C, et al. Ten years of intraoperative floppy iris syndrome in the era of alpha－blockers[J]. Cent European J Urol, 2018, 71(1): 98－104.
[49]
Moore SP, Goggin M. Intraoperative floppy iris syndrome and microincision cataract surgery[J]. J Cataract Refract Surg, 2010, 36(11): 2008.
[50]
叶宏权，韩宇，汤静，等. 同轴微切口白内障超声乳化术控制术中虹膜松弛综合征的疗效分析[J]. 眼科新进展，2017，37(5)：462－465.
[51]
Blau－Most M, Mimouni M, Geffen N, et al. Modified Corneal Incisions for Cataract Surgery in Patients Treated with Tamsulosin: A Prospective Study[J]. Curr Eye Res, 2019, 44(4): 381－384.
[52]
Armarnik S, Mimouni M, Rosen E, et al. Modified corneal incisions in intraoperative floppy iris syndrome (IFIS)－prone patients[J]. Graefes Arch Clin Exp Ophthalmol, 2016, 254(1): 123－127.
[53]
Nguyen DQ, Sebastian RT, Kyle G. Surgeon's experiences of the intraoperative floppy iris syndrome in the United Kingdom[J]. Eye (Lond), 2007, 21(3): 443－444.
[54]
Mylona I, Dermenoudi M, Ziakas N, et al. Increased pupil diameter is a protective factor against intraoperative floppy iris syndrome[J]. Clinical and Experimental Optometry, 2019, 103(5): 704－705.
[55]
Lorente R, de Rojas V, Vazquez DPP, et al. Intracameral phenylephrine 1.5% for prophylaxis against intraoperative floppy iris syndrome: prospective, randomized fellow eye study[J]. Ophthalmology, 2012, 119(10): 2053－2058.
[56]
Guthrie S, Jensen T, Hartley RC, et al. Assessing the accuracy of intracameral phenylephrine preparation in cataract surgery[J]. Eye (Lond), 2018, 32(10): 1615－1620.
[57]
Silverstein SM, Rana VK, Stephens R, et al. Effect of phenylephrine 1.0%－ketorolac 0.3% injection on tamsulosin－associated intraoperative floppy－iris syndrome[J]. J Cataract Refract Surg, 2018, 44(9): 1103－1108.
[58]
Donnenfeld ED, Whitaker JS, Jackson MA, et al. Intracameral ketorolac and phenylephrine effect on intraoperative pupil diameter and postoperative pain in cataract surgery[J]. J Cataract Refract Surg, 2017, 43(5): 597－605.
[59]
Grzybowski A, Kanclerz P. Methods for achieving adequate pupil size in cataract surgery[J]. Curr Opin Ophthalmol, 2020, 31(1): 33－42.
[60]
Nderitu P, Ursell P. Iris hooks versus a pupil expansion ring: Operating times, complications, and visual acuity outcomes in small pupil cases[J]. J Cataract Refract Surg, 2019, 45(2): 167－173.
[61]
Chang DF. Use of Malyugin pupil expansion device for intraoperative floppy－iris syndrome: results in 30 consecutive cases[J]. J Cataract Refract Surg, 2008, 34(5): 835－841.
[62]
Tan R, Wang X, Perera SA, et al. Numerical stress analysis of the iris tissue induced by pupil expansion: Comparison of commercial devices[J]. PLoS One, 2018, 13(3): e194141.
[63]
Lockington D, Wang Z, Qi N, et al. Modelling floppy iris syndrome and the impact of pupil size and ring devices on iris displacement[J]. Eye (Lond), 2020, 12(34): 2227－2234.
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