The most likely pathogenic mechanism for IFIS is the antagonism of α1-adrenergic receptors within the dilator muscle of the iris, which prevent the iris from dilation during surgery. The prevalence also varies among countries and is significantly increased in groups of patients with clinical factors positively correlated with IFIS.Ĭurrently in more recent studies, there is a tendency for higher rates of IFIS, perhaps due to the increasingly high prescription rate of medications associated with IFIS and also because of higher awareness and recognition of milder IFIS signs by surgeons. This wide range of prevalence might be due to the subjective clinical definition of this syndrome and its manifestations being a continuum of severity with variability between patients and between eyes of the same patient. The reported overall prevalence of IFIS in patients undergoing phacoemulsification is variable, ranging from 2% in the Chang and Campbell report in 2005, up to 12.6% in later studies. Therefore, it is important to anticipate IFIS and use pupil expansion devices as a preventive measure in the beginning of surgery rather than after IFIS has developed and the capsulorrhexis is already completed (which might compromise its integrity). diabetes), IFIS is characterized by an elastic iris which does not dilate with mechanical stretching. In contrast to other causes of small dilated pupil and progressive intraoperative miosis (e.g. Two additional pupil features may be present in IFIS:
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