Pediatric intraoperative floppy-iris syndrome.

We report an unusual intraoperative finding in the case of a 4-month-old infant with bilateral congenital cataracts removed within a 1-week period. Surgery in the right eye was uneventful. During removal of the cataract in the left eye, signs of the intraoperative floppy-iris syndrome (IFIS) were observed; ie, iris floppiness, iris prolapse to the incisions, and progressive miosis. The surgical technique was identical in both eyes except that epinephrine was added to the irrigating solution in the right eye but inadvertently omitted in the left-eye surgery. Use of intracameral epinephrine has been documented to prevent IFIS in adult eyes at risk for developing the syndrome. Our case highlights the importance of epinephrine in the irrigating solution in pediatric cataract surgery.