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Purpose Intraoperative floppy iris syndrome (IFIS) caused by systemic α-blockers has been associated with an increased risk of cataract surgical complications when the surgeon was unaware of the medication history and did not anticipate its occurrence. This study was undertaken to evaluate the surgical outcomes and rate of complications when the ophthalmologist knew the patient was taking tamsulosin (Flomax, Boehringer-Ingelheim Pharmaceuticals, Ridgefield, CT) and used 1 of several strategies to manage IFIS. Design Prospective multicenter nonrandomized observational series. Participants A total of 167 consecutive eyes in 135 patients taking tamsulosin and undergoing cataract surgery. Methods Phacoemulsification was performed in conjunction with at least 1 of 4 different IFIS management strategies, namely, topical atropine preoperatively, iris retractors, pupil expansion ring, or use of viscoadaptive ophthalmic viscosurgical device with reduced fluidic parameters. Main Outcome Measures Severity of IFIS, incidence of operative or postoperative complications, and final visual acuity. Results The IFIS severity was rated as mild in 17%, moderate in 30%, and severe in 43% of the study eyes. No IFIS was noted in 10% of the eyes. The rate of posterior capsule rupture and vitreous loss was 0.6% (1/167; 95% confidence interval, 0%–1.8%). Ninety-five percent of eyes achieved a best-corrected visual acuity of at least 20/40. Conclusion When experienced surgeons could anticipate IFIS and employ compensatory surgical techniques, the complication rate from cataract surgery was low and the visual outcomes were excellent in eyes of patients with a history of tamsulosin use.

Forty patients with melanocytoma of the optic disc were evaluated to determine their clinical variations and behavior. Follow-up examination of 1 to 19 years was obtained in 27 patients. Of the 27 lesions, four (15%) showed a slight increase in size, and one tumor (4%) decreased in size. The remaining 22 tumors (81%) have not yet demonstrated ophthalmoscopic changes. In spite of occasional growth, the melanocytoma is a benign tumor that requires no treatment.

With the increased popularity of extracapsular cataract surgery, the need for a peripheral iridectomy has been questioned. Some surgeons feel that the risks involved in performing the iridectomy are greater than when leaving the iris untouched. The indications and risks of iridectomy with cataract surgery are discussed. Four case reports are presented. In three cases, iridectomy was not performed with cataract surgery, and a pupillary block developed. In one of these three, a congenital cataract, secondary angle closure, developed requiring filtering surgery. In the fourth case, an iridectomy prevented serious complications from an unusual degree of postoperative inflammation with complete posterior synechia following uneventful cataract surgery.

The Morning Glory syndrome (MGS) is a congenital optic nerve anomaly that has received scant attention since first described by Handmann in 1929. We studied ten eyes and eight patients displaying variations of the syndrome. We found that the syndrome may be bilateral, hereditary, and associated with other congenital anomalies. When bilateral, visual function was only moderately disturbed. The anomaly is usually limited to the eye, and the retrobulbar nerve and brain appear normal, as documented by ultrasound and computed tomography. Surprisingly, increasing fibrovascular tissue produces traction on the disc substance and vasculature, vitreous, macula, and peripapillary retina. These findings may place these patients within a spectrum of congenital optic nerve anomalies ranging from staphylomata to posterior persistent hyperplastic primary vitreous.