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Editorial |

Tamsulosin and the Intraoperative Floppy Iris Syndrome

Alan H. Friedman, MD
JAMA. 2009;301(19):2044-2045. doi:10.1001/jama.2009.704.
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The intraoperative floppy iris syndrome (IFIS) was first described by Chang and Campbell in 2005.1 These authors1 and others2 observed that there was a tendency for poor pupillary dilation and the intraoperative triad of the billowing of a flaccid iris, the propensity for iris prolapse, and progressive intraoperative pupillary constriction. In the current technique ophthalmologists perform cataract surgery through a 2.5-mm incision. A widely dilated pupil is essential for complication-free surgery. Billowing of the iris into the surgical field and poor pupillary constriction are potentially catastrophic barriers to successful surgery. Intraoperative floppy iris syndrome is encountered mainly in cataract surgery and in prospective studies has been found to occur in 2% to 3% of all cataract operations and to a lesser extent in glaucoma surgery.3

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