Intracameral Phenylephrine in intraoperative floppy iris syndrome

Ana Matheu

Setting: Hospital de l´Esperança. Parc de Salut Mar. Barcelona. Spain.

Objective: To evaluate safety and efficacy of intracameral phenylephrine at 1.66% and at 2.5% to prevent intraoperative floppy iris syndrome during cataract surgery.

Methodes: We present two double-blind prospective studies. In one of them we included 36 eyes of 18 patients who were given topical o intracameral phenylephrine 2.5% for cataract surgery in each eye. Preoperative and postoperative corneal endothelial cell and corneal thickness was recorded. Preoperative, intraoperative and postoperative cardiac frequency and blood pressure were also recorded.
In the other study we included 30 eyes of 15 patients who were taking systemic tamsulosine. One eye of each patient recived intracameral phenylephrine 2.5% and the other eye, 1.66%. We recorded preoperative, intraoperative and postoperative pupil size and we also recorded if prolapse of the iris throught the surgical incision or fluttering and bellowing of the iris occurred.

Results: We find no differences in corneal endothelial cell nor corneal thickness between topical or intracameral phenylephrine. Pulse was lower at the end of surgery in the group who recived intracameral phenylephrine, but this difference was not statiscally significant. Blood pressure was lower at the end of the surgery in the group who recived intracameral phenylephine, and this difference was statistically significant. We also find a major mydriasis in the group reciving intracameral phenylephrine 2.5% at 1 minute of being injected and at the end of the surgery, and this difference was statistically significant. Any eye with intracamerular phenylephrine had prolapse of the iris nor fluttering and bellowing of the iris.

Conclusions: Intracameral phenylephrine 2.5% is safe for the cornea and may reduce the risk for cardiovascular side effects as blood pressure and pulse are lower at the end of the surgery. Intracameral phenylephrine 2.5% also produce a major mydriasis. Intracameral phenylephrine 2.5% and 1.6% are effective in prevent proplapse of the iris throught the incision and bellowing and fluttering of the iris.