Sir,
We thank Dan Nguyen and co-authors for their comments. As rightly pointed out, our paper intends to bring to our colleagues this simple but very effective tool for combating IFIS.
The pupilary dilatation achieved with intracameral phenylephrine is in addition to that achieved with the preoperative 2.5% topical phenylephrine drops used. In addition to increasing pupilary dilatation, intracameral phenylephrine increases the tone of the iris, thus reducing the ‘floppiness’ of the iris that significantly contributes to the effectiveness of this technique
We do not set out to identify the incidence of IFIS in our paper but various papers quote this to be between 43%1 and 65%2 in patients taking Tamsulosin. The range of signs also varies from patient to patient.
Ophthalmic surgeons need to know if their patients are taking Tamsulosin so that they can anticipate and prevent complications due to IFIS. Our technique is part of a growing body of methods to deal with IFIS.
References
Cheung CM, Awan MA, Sandramouli S . Prevalence and clinical findings of tamsulosin-associated intraoperative floppy-iris syndrome. J Cataract Refract Surg 2006; 32 (8): 1336–1339.
Oshika T, Ohashi Y, Inamura M, Ohki K, Okamoto S, Koyama T et al. Incidence of intraoperative floppy iris syndrome in patients on either systemic or topical alpha(1)-adrenoreceptor antagonist. Am J Ophthalmol 2007; 143 (1): 150–151; E-pub 2006 August 28.
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Gurbaxani, A., Packard, R. Response to Nguyen et al. Eye 21, 1120 (2007). https://doi.org/10.1038/sj.eye.6702865
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DOI: https://doi.org/10.1038/sj.eye.6702865
