白内障超声乳化术中虹膜松弛综合征发生的新危险因素和预测指标

目的：观察中国患者虹膜松弛综合征(IFIS)在白内障超声乳化术中的发生率，并探究IFIS的新危险因素及其可能的预测指标。

方法：前瞻性、观察性研究。我们收集了1a内进行白内障手术的患者。记录他们的服药史、散瞳前后的瞳孔直径、IFIS发生的情况。

结果：有中国汉族的白内障手术患者807例1 068眼，共计1 068例手术纳入研究，其中34眼发生了IFIS。进行回归分析发现，以下危险因素与IFIS的发生有关：非那西丁(6.4%，OR=5.885)，坦洛新(25%，OR=21.578)，利血平(16.7%，OR=12.947)，氯氮平(66.7%，OR=139.467)及全视网膜光凝术后(14.3%，OR=10.789)。散瞳后瞳孔直径小，尤其是小于7.25mm的患者更易于发生IFIS(P<0.001)。

结论：中国人群中IFIS的发生率是3.18%。我们发现了3个新的IFIS危险因素：利血平、氯氮平用药史和视网膜光凝术后。术前散瞳困难可能预示着IFIS的发生几率增大。

A study of risk factors and predictive factors in intraoperative floppy iris syndrome during phacoemulsification

AIM: To determine the incidence of intraoperative floppy iris syndrome(IFIS)in patients undergoing phacoemulsification in a Chinese hospital, and to assess new risk factors and predictive factors for IFIS.

METHODS: A prospective, observational case series. In the consecutive cataract surgeries performed in one year, the medicine administration, pupil size(PS)before and after mydriasis, and signs of IFIS were recorded.

RESULTS: Totally 807 patients(1 068 eyes)underwent cataract surgeries. Among the 1 068 eyes, signs of IFIS were noted in 34 eyes. Strong positive correlations were showed between finasteride(6.4%, OR=5.885), tamsulosin(25%, OR=21.578), reserpine(16.7%, OR=12.947), clozapine(66.7%, OR=139.467), post-panretinal photocoagulation(14.3%, OR=10.789)and IFIS. Pupil size was inversely related to IFIS incidence(P<0.001). A dilated pupil smaller than 7.25mm could predict IFIS(P<0.001).

CONCLUSION: The incidence rate of IFIS was 3.18%. Reserpine, clozapine and post-panretinal photocoagulation emerged as new risk factors for IFIS. A small dilated pupil may imply IFIS occurrence.