Prevalence of Intraoperative Floppy Iris Syndrome in Patients Using Calcium Channel Blockers and ARBs as Antihypertensive Medication in Small Incision Cataract Surgery: A Prospective Observational Study

Background: Intraoperative Floppy Iris Syndrome (IFIS) is a condition characterized by iris instability during cataract surgery. It includes features such as a billowing and floppy iris, a tendency for the iris to prolapse toward surgical incisions, and progressive intraoperative miosis. Small Incision Cataract Surgery (SICS) is a popular alternative to phacoemulsification, especially in regions with limited access to advanced phacoemulsification devices. However, due to the smaller and less controlled surgical environment of SICS compared to phacoemulsification, it is important to understand whether antihypertensive drugs like CCBs and ARBs have a similar or more pronounced effect in precipitating IFIS. Objectives: To study the prevalence of IFIS in hypertensive patients undergoing SICS who are treated with CCBs or ARBs and combination of both. Methodology: This prospective observational study conducted at a tertiary care center specializing in cataract surgery over a 12-month period including 50 hypertensive patients aged 50 years or older who were undergoing SICS classified in 3 groups each (150). Results: Prevalence of IFIS in our study was 4% in the patients receiving CCBs. Prevalence of IFIS in our study was 6% in the patients receiving ARBs. Prevalence of IFIS in our study was 8% in the patients receiving CCB+ARB combination of drugs. In the group of patients receiving CCBs, prevalence was 4% in the age of above 70 years, patients receiving ARBs, the prevalence was 2% in 60-70 years and 4% in the age of above 70 years and patients receiving combination of both CCB+ARBs, the prevalence was 2% in 51-60 and 61-70 years and 4% in the age of above 70 years. Gender wise prevalence of IFIS in our study revealed 2% each in male and female in CCB group, 4% males and 2% females in ARB group and 4% each male and females in the combination group. Conclusion: Prevalence of IFIS in our study was 4% in the patients receiving CCBs. Prevalence of IFIS in our study was 6% in the patients receiving ARBs. Prevalence of IFIS in our study was 8% in the patients receiving CCB+ARB combination of drugs. We observed the prevalence of IFIS as 4% in patients receiving CCBs, 6% in patients receiving ARBs and 8% in patients receiving combination of CCB+ARBs.