Department of Ophthalmology, Clinic Hietzing, Vienna Healthcare Group, Vienna, Austria.
Karl Landsteiner Institute of Process Optimization and Quality Management in Cataract Surgery, Clinic Hietzing, Vienna, Austria.
Graefes Arch Clin Exp Ophthalmol. 2024 Jan;262(1):103-111. doi: 10.1007/s00417-023-06165-3. Epub 2023 Jul 10.
To aid preoperative risk assessment by identifying anatomic parameters corresponding with a higher risk of intraoperative floppy iris syndrome (IFIS) during cataract surgery.
Prospective cohort study of 55 patients with α-adrenergic receptor antagonist (α-ARA) treatment and 55 controls undergoing cataract surgery. Anterior segment optical coherence tomography (AS-OCT), video pupilometer, and biometry measurements were performed preoperatively and analyzed regarding anatomic parameters that corresponded with a higher rate of IFIS. Those statistically significant parameters were evaluated with logistic regression analysis and receiver operating characteristic (ROC) curve.
Pupil diameter was significantly smaller in patients who developed IFIS compared to those who did not develop IFIS (AS-OCT 3.29 ± 0.85 vs. 3.63 ± 0.68, p = 0.03; Pupilometer 3.56 ± 0,87 vs. 3.95 ± 0.67, p = 0.02). Biometric evaluation revealed shallower anterior chambers in the IFIS group (ACD 3.12 ± 0.40 vs. 3.32 ± 0.42, p = 0.02). Cutoff values for 50% IFIS probability (p = 0.5) were PD = 3.18 mm for pupil diameter and ACD = 2.93 mm for anterior chamber depth. ROC curves of combined parameters were calculated for α-ARA medication with pupil diameter and anterior chamber depth, which yielded an AUC of 0.75 for all IFIS grades.
The combination of biometric parameters with history of α-ARA medication can improve assessment of risk stratification for IFIS incidence during cataract surgery.
通过识别与白内障手术期间术中软性虹膜综合征（IFIS）风险较高相关的解剖参数，来辅助术前风险评估。
对 55 例接受 α-肾上腺素能受体拮抗剂（α-ARA）治疗的患者和 55 例接受白内障手术的对照者进行前瞻性队列研究。对术前进行眼前段光学相干断层扫描（AS-OCT）、视频瞳孔计和生物测量，并分析与 IFIS 发生率较高相关的解剖参数。对这些具有统计学意义的参数进行逻辑回归分析和接收者操作特征（ROC）曲线评估。
与未发生 IFIS 的患者相比，发生 IFIS 的患者瞳孔直径明显更小（AS-OCT 为 3.29 ± 0.85 比 3.63 ± 0.68，p = 0.03；Pupilometer 为 3.56 ± 0.87 比 3.95 ± 0.67，p = 0.02）。生物测量评估显示 IFIS 组前房较浅（ACD 为 3.12 ± 0.40 比 3.32 ± 0.42，p = 0.02）。IFIS 概率为 50%（p = 0.5）的截断值为瞳孔直径为 3.18mm 和前房深度为 2.93mm。计算了合并参数（包括 α-ARA 药物治疗、瞳孔直径和前房深度）的 ROC 曲线，得出所有 IFIS 分级的 AUC 为 0.75。
将生物计量学参数与 α-ARA 药物治疗史相结合，可以改善对白内障手术中 IFIS 发生率的风险分层评估。
