The Pharmacological Mydriatic Pupil-to-Limbal Diameter Ratio as an Intuitive Predictor for the Risk of Intraoperative Floppy Iris Syndrome

Purpose. To predict development of intraoperative floppy iris syndrome (IFIS) using the preoperative pharmacologically dilated pupil-to-limbal diameter (PL) ratio. Methods. The subjects were male patients treated by phacoemulsification who were or were not taking α1-adrenoceptor antagonists (ARAs). The PL ratio was calculated from the horizontal dilated pupil diameter and the horizontal corneal white-to-white distance measured by two observers in surgical videos. IFIS severity was graded using the criteria of Chang et al. We predicted the intuitive PL ratio to describe how precisely the experimenter can estimate the PL ratio without any tools. Results. There were 36 eyes in the α1-ARA group and 48 eyes in the control group. The pupil diameter and PL ratio were both significantly smaller in the α1-ARA group compared to the control group (p