Addressing Floppy Iris Syndrome During Cataract Surgery

The reluctant pupil can be managed with preoperative evaluation and modified surgical techniques.

By: Axel Rivas, BS, Michelle L. Huynh, MD, Claire Wright, MD

Ophthalmology Management January 20, 2026 Vol 30, Issue Cataract and Refractive 2026

Clinical Report: Addressing Floppy Iris Syndrome During Cataract Surgery

Overview

This report discusses the management of intraoperative floppy iris syndrome (IFIS) during cataract surgery, highlighting the surgical challenges faced and the techniques employed to address them. A case study of a 71-year-old female patient illustrates the complexities of IFIS and the importance of preoperative evaluation.

Background

Intraoperative floppy iris syndrome (IFIS) presents significant challenges during cataract surgery, particularly in patients with complex anterior-segment anatomy. Understanding the risk factors associated with IFIS, including certain medications and patient demographics, is crucial for optimizing surgical outcomes. Effective management strategies are essential to mitigate complications and ensure patient safety during cataract procedures.

Data Highlights

No numerical data or trial data presented in the article.

Key Findings

IFIS is characterized by iris billowing, iris prolapse, and progressive miosis.
Risk factors for IFIS include advanced age, male sex, small preoperative pupil size, and certain medications.
Preoperative evaluation and modified surgical techniques can effectively manage IFIS.
Mechanical pupil expansion devices, such as iris hooks, are beneficial when pharmacologic dilation is insufficient.
Intracameral moxifloxacin can be used to ensure all incisions are watertight at the end of surgery.

Clinical Implications

Surgeons should conduct thorough preoperative assessments to identify patients at risk for IFIS and prepare appropriate management strategies. Utilizing mechanical devices for pupil expansion may enhance surgical efficiency and reduce complications during cataract surgery.

Conclusion

Addressing IFIS requires a multifaceted approach that includes preoperative planning and intraoperative adaptability. Awareness of the condition and its management can significantly improve surgical outcomes in cataract procedures.

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