| Preoperative topical administration of atropine eye drops |
Although atropine is hardly ever used nowadays because of its long-term effects, individual case reports testify to its positive effect in IFIS (7, 14, 19, e21). |
| Intraoperative intracameral administration of phenylephrine/epinephrine |
In addition to the preoperative topical administration of mydriatic eye drops, a sympathomimetic drug can be administered into the anterior chamber during the procedure. According to several studies, the intracameral administration of epinephrine or phenylephrine did not yield unequivocally positive effects (19, 20, e4, e17). |
| Use of ophthalmic viscoelastic device (OVD) |
By administering an ophthalmic viscoelastic device into the anterior chamber at the pupillary level, the pupil can be dilated. However, this effect wears off during the operation, since the viscoelastic solution continually drains from the anterior chamber, or it is aspirated during phacoemulsification (7). |
| Mechanical dilation of the pupil |
In case of insufficient mydriasis, pupil stretching—occasionally even sphincterotomy of the iris muscles—can help improve mydriasis. This strategy is ineffective in case of an atonic iris in IFIS. The use of mechanical devices, such as iris retractors or pupil expanders, yielded greater success rates (6, 18). |
| Surgical techniques |
Some authors have reported that when using microincisional techniques (MICS), greater stability in the anterior chamber and reduced throughflow can contribute to improved stability of the iris. Similarly, constructing the accesses in a particularly careful manner can prevent iris prolapse or at least make it less likely (e22, e23). |
| Stopping treatment? |
Clinical practice has shown that stopping tamsulosin treatment does not lead to any improvement, which can be explained with the long half life and resulting anatomical changes, which, in contrast to the effect on the receptor, are irreversible (11, 21). This should prompt critical weigh‧ing-up of the benefits and risks (urinary retention?) of stopping the treatment (7, 13, e26). It has been shown that in patients receiving combination treatment with tamsulosin and the 5-alpha reductase inhibitor dutasteride, stopping treatment with tamsulosin is perfectly feasible in a scenario of mild to moderate LUTS after an initial phase of combination treatment, without the symptoms deteriorating. The combination therapy should, however, be given for about six months (e24). |
