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1 = 증례보고 = 백내장수술중발생하는홍채이완증후군의유병률및위험인자 대한안과학회지 2014 년제 55 권제 1 호 J Korean Ophthalmol Soc 2014;55(1):73-78 pissn: eissn: 박호균 최상경 중앙보훈병원안과 목적 : 백내장수술중발생하는홍채이완증후군 (Intraoperative floppy iris syndrome, IFIS) 의유병률과위험인자에대해알아보고자하였다. 대상과방법 : 백내장수술환자 655 명 981 안을대상으로 IFIS 의발생및 grade 를확인하고, 이에영향을미치는위험인자를알기위해 α 1- 교감신경길항제 (tamsulosin, terazosin, alfuzosin), benzodiazepine, 5-α-reductase inhibitor, 연령, 성별, 고혈압, 당뇨및녹내장과의상관관계를분석하였다. 결과 : 981 안중 178 안 (18.1%) 에서 IFIS 가발생하였다. α1- 교감신경길항제, benzodiazepine, 남성은 IFIS 발생과유의한관련성이있었으나 5-α-reductase inhibitor, 연령, 고혈압, 당뇨, 녹내장은관련성이없었다. α 1- 교감신경길항제의누적복용량이많을수록 IFIS grade 가높았으며, 그중 tamsulosin 의교차비가가장높아 terazosin 의 3.8 배, alfuzosin 의 9.0 배, benzodiazepine 의 11.1 배였다. 양안수술환자중 1 안이상 IFIS 로진단된경우양안의 IFIS grade 차이는없었다. 결론 : α 1- 교감신경길항제와 benzodiazepine 은 IFIS 발생에위험요소로작용하고, α 11- 교감신경길항제의누적복용량이많을수록높은 grade 의 IFIS 를발생시킬수있으므로수술전이를예상하여대비가필요하다. 또한양안수술시첫번째수술안의 IFIS 양상을두번째수술안의예측인자로활용할수있을것이다. < 대한안과학회지 2014;55(1):73-78> 백내장수술시발생하는홍채이완증후군 (Intraoperative floppy iris syndrome, IFIS) 은 2005년 Chang and Campbell 1 에의해처음소개되었으며수술중홍채의펄럭임, 진행성동공축소, 각막절개창으로의홍채탈출소견을특징으로한다. 수술중충분한동공확대와안정적인홍채유지는성공적인백내장수술을위한필수조건이다. 그러나 IFIS가발생하면수술시야가좁아지고, 안정적인홍채유지가어려워수정체낭원형절개의실패, 후낭파열, 전방출혈과같은합병증이일어나백내장수술시어려움을겪는다. 2,3 2005년이후 IFIS의발생을줄이고수술의안정성을높이기위해 IFIS 의원인을규명하는연구가진행되어왔으며, Chatziralli and Sergentanis 4 는 IFIS와관련된연구들을메타분석하여 IFIS의발생은전립선비대증치료제인 α 1-교감신경길항제의복용과관련성이있고, 이중 tamsulosin이높은관련성 Received: Revised: Accepted: Address reprint requests to Sangkyung Choi, MD Department of Ophthalmology, Veterans Health Service Medical Center, #53 Jinhwangdo-ro 61-gil, Gangdong-gu, Seoul , Korea Tel: , Fax: drskchoi@hanmail.net 이있다고보고하였다. 국내에서는 Shin et al 5 이최초로 IFIS 1예를보고한것과, Kim et al 6 이백내장수술일주일전 α 1-교감신경길항제복용중단이 IFIS 예방에는효과가없었다고한연구이외에한국인에서의 IFIS 유병률과그위험요소들에대한연구는전무하다. 이에저자들은 IFIS의발생과이에관여하는위험요소들을확인하여 IFIS의위험성을예측하고대비하여안정적으로백내장수술을시행하는데도움이되고자하였다. 대상과방법 2011년 10월부터 2012년 10월까지본원에서수정체유화술및인공수정체후방삽입술을받은환자 655명 981안을대상으로하였다. 안수술력, 외상력, 선천성홍채기형, 홍채종양, 급성패쇄각녹내장으로인한홍채손상, 안내염으로인한홍채유착이있거나, 조절마비제, 축동제를지속적으로사용하는경우는대상에서제외하였다. 환자들이복용중인 α 1-교감신경길항제는 tamsulosin (Harnal-D 0.2 mg, Astellas Pharma Inc., Japan), terazosin (Hytrine 2 mg, 5 mg Ilyang Pharma Inc., Korea), alfuzosin (Xatral XL 10 mg, Sanofi Synthelabo Pharma Inc., Japan) 이었고,

2 - 대한안과학회지 2014 년제 55 권제 1 호 - α-reductase inhibitor 는 finasteride (Finastin 5 mg, Bugwang Pharma Inc., Korea) 였으며, benzodiazepine은 alfrazolam (Zanapam 1 mg, Myungin Pharma Inc., Korea), clonazepam (Rivotril 0.5 mg, Roche, Switzerland), diazepam (Diazepam 2 mg, Samjin Pharma Inc., Korea) 이었다. 모든수술은단일술자에의해시행되었으며, 수술 1시간 30 분전부터 Mydrin-P (0.5% tropicamide and 0.5% phenylephrine hydrochloride, Santen Pharm, Osaka, Japan) 를 15분간격으로 6회점안하여산동시켰다. Alcaine (propacaine hydrochloride 0.5%, Alcon Laboratories, Fort Worth, TX, USA) 을이용한점안마취와 2% lidocaine 2 ml 용량으로구후마취후일회용각막절개도로이측각막을 2.75 mm 절개한후수정체낭원형절개술을시행하고관류액 (BSS, Alcon Laboratories, Fort Worth, TX, USA) 을사용하여수력분리술과수력분층술을시행한뒤, 초음파기계 (Infiniti, Alcon, USA) 로수정체유화술을시행한후인공수정체를삽입하였다. IFIS의중증도분류는 grade 1이특징적인홍채펄럭임과진행성동공수축이나타나는경우, grade 2는진행성동공수축과홍채펄럭임이심하여각막절개부위로홍채가탈출하는경향이약하게나타나는경우, grade 3은매우심한진행성동공수축과함께홍채펄럭임이매우심하여각막절개부위로홍채가탈출하는경향이강하게나타나는경우로하였다. IFIS의발생과 tamsulosin, terazosin, alfuzosin, benzodiazepine, finasteride, 연령, 성별, 고혈압, 당뇨병및녹내장과의상관관계를분석하였고, tamsulosin, terazosin, alfuzosin 각각의약물에대한누적복용량 ( 복용량 복용기간 ) 과 IFIS 중증도와의상관관계를분석하였다. 양안수술환자중 1안이상 IFIS로진단된경우양안의 IFIS grade 를비교하였다. 통계분석은 SPSS 18.0 for window (SPSS Inc.) 프로그램을사용하였고, p<0.05 를통계학적으로의미있다고보았다. Chi-squared test를이용하여 IFIS의위험인자들을분석하였고, 이분형로지스틱회귀분석을이용하여 IFIS발생과위험인자들사이의교차비를알아보았다. Kendall s tau-b 를이용하여 IFIS grade 와 α 1-교감신경길항제누적복용량사이의상관관계를분석하였으며, wilcoxon signed rank test를사용하여 1안이상 IFIS로진단된양안수술환자의경우양안의 IFIS grade를비교하였다. 결과 연구대상은 655명 981안이었으며평균연령은 73.1 ± 7.8세였다. 남자는 504명 757안, 여자는 151명 224안이었다 (Table 1). 981안중 178안 (18.1%) 에서 IFIS가발생하였고, 그정도는 grade 1, 2, 3이각각 111안 (62.4%), 36안 (20.2%), 31안 (17.4%) 이었다. α 1-교감신경길항제를복용중인 269 안중 IFIS가발생한 153안 (56.8%) 의복용제제별 IFIS grade는 tamsulosin의경우 grade 1, 2, 3이 76안 (64.4%), 24안 (20.3%), 18안 (15.3%) 이었고, terazosin은 9안 (40.9%), 6안 (27.3%), 7안 (31.8%) 이었으며, alfuzosin은 11안 (84.6%), 0안, 2안 (15.4%) 이었다. Benzodiazepine은 grade 1, 2, 3이 Table 1. Demographic characteristics of patients (655 patients, 981 eyes) IFIS (n = 178) Non-IFIS (n = 803) All subjects (n = 981) Age (years) 73.1 ± ± ± 7.8 Sex Male 175 (98.3%) 582 (72.4%) 757 (77.2%) Female 3 (1.7%) 221 (27.6%) 224 (22.8%) Values are presented as mean ± SD. IFIS = intraoperative floppy iris syndrome; SD = standard deviation. Table 2. Profile of intraoperative floppy iris syndrome grade Grade 1 (%) Grade 2 (%) Grade 3 (%) Total IFIS, eyes 111 (62.4) 36 (20.2) 31 (17.4) 178 α-adrenergic antagonist 96 (62.7) 30 (19.6) 27 (17.7) 153 Tamsulosin 76 (64.4) 24 (20.3) 18 (15.3) 118 Terazosin 9 (40.9) 6 (27.3) 7 (31.8) 22 Alfuzosin 11 (84.6) 0 (0) 2 (15.4) 13 Benzodiezepine 21 (56.8) 14 (37.8) 2 (5.4) 37 Finasteride 13 (81.3) 2 (12.5) 1 (6.2) 16 IFIS = intraoperative floppy iris syndrome. 74

3 - 박호균 최상경 : 홍채이완증후군의유병률및위험인자 - Table 3. Frequency of potential risk factors in subjects with and without intraoperative floopy iris syndrome Risk Factors IFIS Non-IFIS N No. Cases (%) N No. Cases (%) p-value * α-adrenergic antagonist (85.9) (14.4) <0.001 Tamsulosin (66.3) (6.5) <0.001 Terazosin (12.4) (4.2) <0.01 Alfuzosin (7.3) (3.7) Benzodiazepine (20.8) (7.3) <0.001 Finasteride (9.0) (3.6) Sex, male (98.3) (72.4) <0.001 Hypertension (50.6) (57.1) Diabetes mellitus (32.6) (31.2) Glaucoma (6.7) (7.8) IFIS = intraoperative floppy iris syndrome. * Chi-squared test. Table 4. Potential risk factors associated with intraoperative floppy iris syndrome Odds ratio Confidence interval p-value * Tamsulosin <0.001 Terazosin <0.001 Alfuzosin <0.001 Benzodiazepine <0.001 Finasteride Duration of α-adrenergic antagonist Age Sex, male Hypertension Diabetes mellitus Glaucoma * Binominal logistic regression analysis. Table 5. Correlation analysis of IFIS grade and cumulative dosage of α-adrenergic antagonist Cumulative dosage (mg) Kendall τ coefficient p-value * Tamsulosin 5.16 ± <0.001 Terazosin 4.69 ± <0.001 Alfuzosin 4.31 ± <0.001 Values are presented as mean ± SD. * Kendall s tau-b analysis. 21안 (56.8%), 14안 (37.8%), 2안 (5.4%) 이었고, finasteride 는 13안 (81.3%), 2안 (12.5%), 1안 (6.2%) 이었다 (Table 2). IFIS가발생한 178안을비교분석한결과 tamsulosin, terazosin, alfuzosin, benzodiazepine, 남성은 IFIS 발생에유의한관련성이있었고, finasteride, 고혈압, 당뇨, 녹내장은관련성이없었다 (Table 3). 이분형로지스틱회귀분석으로각인자에대한교차비 (odds ratio, OR) 를산출하였고, 그결과 tamsulosin의 OR은 (95% CI (confidence interval) ) 로 terazosin (OR, ) 보다 3.8배, alfuzosin (OR, 8.220) 보다 9.0배, benzodiazepine (OR, 6.703) 보다 11.1배높은상관관계를보였다. 남성과 α 1-교감신경길항제의복용기 간도 IFIS발생과유의한관련성이있었다 (Table 4). Kendall s tau-b를이용하여 IFIS의 grade와 tamsulosin, terazosin, alfuzosin의누적복용량과의관계를분석하였다. 누적복용량은 tamsulosin, terazosin, alfuzosin이각각 5.16 ± 3.7 mg, 4.69 ± 2.58 mg, 4.31 ± 2.49 mg이었고, tamsulosin, terazosin, alfuzosin 의상관계수는각각 0.449, 0.132, 0.164로 tamsulosin이가장높은상관관계를보였다 (Table 5). 양안백내장수술을받은환자 326명중양안모두 IFIS 로진단된환자는 43명이었고, 단안만 IFIS로진단된환자는 21명이었다. Wilcoxon signed rank test를이용하여양안수술환자중 1안이상 IFIS로진단된경우양안의 IFIS 75

4 - 대한안과학회지 2014 년제 55 권제 1 호 - Table 6. Differences of the IFIS grades between both eyes of the patients who underwent cataract surgery of both eyes and diagnosed with intraoperative floppy iris syndrome ΔGrade between both eyes p-value * Total (n = 64) 0.45 ± * IFIS (+) in both eyes (n = 43) 0.16 ± * IFIS (+) in one eye (n = 21) 1.04 ± * Values are presented as mean ± SD. ΔGrade = grade diffrerences between both eyes; IFIS = intraoperative floppy iris syndrome. * Wilcoxon signed rank test. grade 는차이가없었다 (Table 6). 고찰 전립선비대증치료제로사용되는 α 1-교감신경길항제는대표적으로 tamsulosin, terazosin, alfuzosin이있으며, 수술중홍채의펄럭임, 진행성동공축소, 각막절개창으로홍채의탈출을특징으로하는 IFIS를발생시킬수있다. 1,7-9 그기전은 α 1-교감신경수용체가요도, 방광이외에홍채이완근과섬모체에도분포하는데, 10,11 세가지약물모두 α 1- 교감신경수용체에작용하기때문에전립선비대증치료를위해약물을복용할경우, 홍채이완근에도동시에영향을미쳐 IFIS를발생시키는것으로알려졌다 백내장수술의경우 IFIS의발생은수술합병증을유발시킬수있으므로 2,3 IFIS의원인을밝히기위한연구가지속되어왔으며, 최근 α 1-교감신경길항제외에고혈압, 15 benzodiazepine, 16 5-α-reductase inhibitor, 16 labetalol 17 등이 IFIS 발생에관여한다는보고가있다. 이번연구에서백내장수술중 IFIS의유병률은 18.1% 로이전연구들의결과인 % 보다높았는데, 이것은본원의특성상고령남자환자들의분포가매우높아서전립선비대증으로 α 1-교감신경길항제를복용하고있는환자들이일반병원에비해월등히많기때문이었다. α 1-교감신경길항제를복용하는환자에서 IFIS의발생률은 56.8% 로이전연구결과들 (38-90%) 과큰차이는없었다. 7,18,19 α 1- 교감신경길항제중특히 tamsulosin의 OR은 terazosin 보다 3.8배, alfuzosin 보다 9.0배, benzodiazepine 보다 11.1 배높아 IFIS의발생과가장높은관련성이있음을알수있었다. Santaella et al 20 과 Prata et al 21 은 α 1-교감신경길항제를 1년이상장기간복용한경우홍채이완근의두께가얇아졌다고보고하면서복용기간이길면홍채이완근의위축이심하게나타나서중증의 IFIS가발생할수있음을시사한바있다. Oshika et al 19 은 tamsulosin 0.2 mg/day를복용하는일본인과 0.4 mg/day 를복용하는미국인의 IFIS 유병률을각각 37.9%, 63% 로보고하여 IFIS가복용량과 관련성이있다고보고하였다. 본연구에서는 tamsulosin, terazosin, alfuzosin 각각의누적복용량을산출하여 IFIS와의상관관계를분석한결과누적복용량이클수록 IFIS grade 가높아지는상관관계를보였으며, 특히 tamsulosin이가장큰상관관계를보였다. 또한 benzodiazepine 도 IFIS 발생과관련성이있었다. Benzodiazepine은진정, 수면및신경안정을목적으로사용되는약제로그수용체가홍채와섬모체를포함하여눈전반에걸쳐분포하고있어 22 생화학적으로 IFIS를발생시킬가능성이입증되었으므로, 백내장수술전진정, 수면이나항불안목적으로사용할경우주의를기울여야할것으로생각한다. Finasteride 는 IFIS 발생과관련성이없었다. Finasteride 는 testosterone 이 dihydrotestosterone으로전환되는것을억제하여최근전립선비대증및전립선암의치료제로널리사용되고있는약제로 IFIS를일으킬수있는기전은설명되지않는다. 그러나 Issa and Dagres 23 와 Wong and Mak 24 는 finasteride를복용한환자에서 IFIS가발생하였음을보고하였고, Chatziralli et al 16 도기전은명확하지않지만, finasteride가 IFIS 발생과상관관계가있다고보고한바, 추후 finasteride와 IFIS의상관관계와그기전에대한추가적인연구가필요할것이다. 또한남성이 IFIS발생과유의한관련성이있었는데이는주로남성들이전립선비대증으로인한배뇨장애를개선하기위해 α 1-교감신경길항제를복용하기때문으로생각된다. 그러나최근들어배뇨장애치료를위해 α 1-교감신경길항제를복용하는여성환자들도늘어나고있는추세여서여성환자의 IFIS 발생률은증가될것으로예측된다. 본연구에서고혈압은 IFIS의발생과관련성이없었으나, 고혈압과 IFIS의발생에대한의견은다양하다. Altan-Yaycioglu et al 25 은고혈압과 IFIS의발생은관련성이없다고보고하였고, 이와다르게 Neff et al 15 은원인은명확하지않으나고혈압이 IFIS의발생과의미있는관계가있다고보고하였다. Calotti and Steen 17 은 α 1, β 1, β 2 교감신경수용체에작용하는항고혈압약물인 labetalol에의해 IFIS가발생하였다고보고하였는데, 향후교감신경계수용체에작용하는항고혈압성약물들과 IFIS발생사이에상관관계를밝히는 76

5 - 박호균 최상경 : 홍채이완증후군의유병률및위험인자 - 연구가필요할것이다. 또한이번연구에서연령과당뇨병도 IFIS의발생과관련성이없었으나, 고령환자와당뇨환자에서초음파유화술중동공수축이일어나는경향이있다고보고된바있어 26,27 이에대한추가연구가필요할것으로생각한다. 한편양안수술환자중 1안이상 IFIS로진단된경우양안의 IFIS grade 에는차이가없었다. 이는 IFIS발생의주원인이되는 α 1-교감신경길항제의복용이양안홍채이완근에존재하는 α 1-교감신경수용체에동일한영향을주기때문일것이며, 첫번째수술안에서발생된 IFIS의정도를경험함으로써반대편수술안의 IFIS 발생과 grade를예측할수있을것으로생각한다. 결론적으로 α 1-교감신경길항제와 benzodiazepine은 IFIS 발생에위험요소로작용하며, α 1-교감신경길항제의누적복용량이많을수록높은 grade의 IFIS를발생시킬수있으므로이를예상하여수술전충분히산동시키는등의대비가필요하며, 수술전환자에게합병증발생의가능성에대해부가설명함이바람직할것이다. 그리고수술중홍채펄럭임이발생하는경우낮은흡입속도와흡입력을유지하면서전방을유지시키고, 진행성동공축소에대비하여점성과보유력이좋은점탄물질을사용하거나 iris retractor 와같은홍채확장기구를이용하여최대한수술시야를확보하는등의노력이필요할것이다. 또한양안백내장수술시첫번째수술안의 IFIS 발생여부및 grade를두번째수술안의예측인자로활용할수있을것이다. REFERENCES 1) Chang DF, Campbell JR. Intraoperative floppy iris syndrome associated with tamsulosin. J Cataract Refract Surg 2005;31: ) Bell CM, Hatch WV, Fischer HD, et al. Association between tamsulosin and serious ophthalmic adverse events in older men following cataract surgery. JAMA 2009;301: ) Chang DF, Braga-Mele R, Mamalis N, et al. Clinical experience with intraoperative floppy-iris syndrome. Results of the 2008 ASCRS member survey. J Cataract Refract Surg 2008;34: ) Chatziralli IP, Sergentanis TN. Risk factors for intraoperative floppy iris syndrome: a meta-analysis. Ophthalmology 2011;118: ) Shin KH, Sohn HJ, Lee DY, Nam DH. A case of intraoperative floppy iris syndrome in a patient using tamsulosin. J Korean Ophthalmol Soc 2009;50: ) Kim EK, Chung SK, Baek NH. The effect of α1-adrenergic blocker on phacoemulsification. J Korean Ophthalmol Soc 2012;53: ) Blouin MC, Blouin J, Perreault S, et al. Intraoperative floppy-iris syndrome associated with alpha1-adrenoreceptors: comparison of tamsulosin and alfuzosin. J Cataract Refract Surg 2007;33: ) Settas G, Fitt AW. Intraoperative floppy iris syndrome in a patient taking alfuzosin for benign prostatic hypertrophy. Eye (Lond) 2006;20: ) Venkatesh R, Veena K, Gupta S, Ravindran RD. Intraoperative floppy iris syndrome associated with terazosin. Indian J Ophthalmol 2007;55: ) Michel MC, Okutsu H, Noguchi Y, et al. In vivo studies on the effects of alpha1-adrenoceptor antagonists on pupil diameter and urethral tone in rabbits. Naunyn Schmiedebergs Arch Pharmacol 2006;372: ) Nakamura S, Taniguchi T, Suzuki F, et al. Evaluation of alpha1-adrenoceptors in the rabbit iris: pharmacological characterization and expression of mrna. Br J Pharmacol 1999;127: ) Yu Y, Koss MC. Functional characterization of alpha-adrenoceptors mediating pupillary dilation in rats. Eur J Pharmacol 2003; 471: ) Clarke RJ, Zhang H, Gamlin PD. Characteristics of the pupillary light reflex in the alert rhesus monkey. J Neurophysiol 2003;89: ) Wikberg-Matsson A, Uhlén S, Wikberg JE. Characterization of alpha(1)-adrenoceptor subtypes in the eye. Exp Eye Res 2000;70: ) Neff KD, Sandoval HP, Fernández de Castro LE, et al. Factors associated with intraoperative floppy iris syndrome. Ophthalmology 2009;116: ) Chatziralli IP, Sergentanis TN, Papazisis L, Moschos MM. Risk factors for intraoperative floppy iris syndrome: a retrospective study. Acta Ophthalmol 2012;90:e ) Calotti F, Steen D. Labetalol causing intraoperative floppy-iris syndrome. J Cataract Refract Surg 2007;33: ) Takmaz T, Can I. Clinical features, complications, and incidence of intraoperative floppy iris syndrome in patients taking tamsulosin. Eur J Ophthalmol 2007;17: ) Oshika T, Ohashi Y, Inamura M, et al. Incidence of intraoperative floppy iris syndrome in patients on either systemic or topical alpha(1)-adrenoceptor antagonist. Am J Ophthalmol 2007;143: ) Santaella RM, Destafeno JJ, Stinnett SS, et al. The effect of alpha1-adrenergic receptor antagonist tamsulosin (Flomax) on iris dilator smooth muscle anatomy. Ophthalmology 2010;117: ) Prata TS, Palmiero PM, Angelilli A, et al. Iris morphologic changes related to alpha(1)-adrenergic receptor antagonists implications for intraoperative floppy iris syndrome. Ophthalmology 2009;116: ) Zarbin MA, Anholt RR. Benzodiazepine receptors in the eye. Invest Ophthalmol Vis Sci 1991;32: ) Issa SA, Dagres E. Intraoperative floppy-iris syndrome and finasteride intake. J Cataract Refract Surg 2007;33: ) Wong AC, Mak ST. Finasteride-associated cataract and intraoperative floppy-iris syndrome. J Cataract Refract Surg 2011;37: ) Altan-Yaycioglu R, Gedik S, Pelit A, et al. Clinical factors associated with floppy iris signs: a prospective study from two centers. Ophthalmic Surg Lasers Imaging 2009;40: ) Abdel-Aziz S, Mamalis N. Intraoperative floppy iris syndrome. Curr Opin Ophthalmol 2009;20: ) Mirza SA, Alexandridou A, Marshall T, Stavrou P. Surgically induced miosis during phacoemulsification in patients with diabetes mellitus. Eye (Lond) 2003;17:

6 - 대한안과학회지 2014 년제 55 권제 1 호 - =ABSTRACT= Incidence and Risk Factors of Intraoperative Floppy Iris Syndrome During Cataract Surgery Ho Gyun Park, MD, Sangkyung Choi, MD Department of Ophthalmology, Veterans Health Service Medical Center, Seoul, Korea Purpose: To determine the incidence and risk factors of intraoperative floppy iris syndrome (IFIS) in patients undergoing cataract surgery. Methods: The present study included 981 eyes of 655 patients who underwent cataract surgery and development and grade of IFIS were recorded. Correlation analysis was performed to determine the relationship between the IFIS and risk factors such as α 1-adrenergic antagonist (tamsulosin, terazosin, alfuzosin), benzodiazepine, 5-α-reductase inhibitor, age, gender, hypertension, diabetes and glaucoma. Results: IFIS developed in 178 eyes (18.1%) out of 981 eyes. There was a correlation between the development of the IFIS and α 1-adrenergic antagonist and benzodiazepine and male gender; however, there was no correlation with 5-α -reductase inhibitor, age, gender, hypertension, diabetes and glaucoma. IFIS grade tended to be higher as the cumulative dosage of the α 1-adrenergic antagonist increased. Odds ratio of the patients using tamsulosin was the highest among the other risk factors, which was 3.8 times higher than the patients using terazosin, 9.0 times higher than the patients using alfuzosin and 11.1 times higher than the patients using benzodiazepine. Among patients who underwent cataract surgery on both eyes and who were confirmed with IFIS in 1 or both eyes, no significant grade differences between the 2 eyes were noted. Conclusions: Alpha 1-adrenergic antagonist and benzodiazepine were risk factors for the development of the IFIS, and as the cumulative dosage of the α 1-adrenergic antagonist increased, the probability of developing a higher grade of IFIS increased. Therefore, predicting and preparing for potential IFIS in patients who have the above-mentioned risk factors are necessary before planning cataract surgery. Additionally, the IFIS aspect of the first eye could be utilized as a predictive value for developing IFIS profile of the fellow eye. J Korean Ophthalmol Soc 2014;55(1):73-78 Key Words: Alpha 1-adrenergic antagonist, Benzodiazepine, Cataract surgery, Intraoperative floppy iris syndrome Address reprint requests to Sangkyung Choi, MD Department of Ophthalmology, Veterans Health Service Medical Center #53 Jinhwangdo-ro 61-gil, Gangdong-gu, Seoul , Korea Tel: , Fax: , drskchoi@hanmail.net 78

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< D30352D303328B1E8C0BAB0E62DB9E9B3B2C8A D E687770> 대한안과학회지 2012 년제 53 권제 2 호 J Korean Ophthalmol Soc 2012;53(2):256-261 pissn: 0378-6471 eissn: 2092-9374 http://dx.doi.org/10.3341/jkos.2012.53.2.256 = 증례보고 = 알파 1- 교감신경길항제가수정체유화술에미치는영향 김은경 1 정성근 1 백남호 2