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Bigdon E, Casagrande M, Spitzer MS, Hassenstein A. [Intraoperative floppy iris syndrom (IFIS) associated with tamsulosin]. Aktuelle Urol 2022; 53:246-253. [PMID: 33694138 DOI: 10.1055/a-1199-6900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Tamsulosin is one of the most commonly prescribed alpha-1A antagonists for the treatment of benign prostatic syndrome (BPS). Patients treated with tamsulosin often develop intraoperative floppy iris syndrome (IFIS) during cataract surgery. This leads to increasing miosis and an undulating iris, which increases the risk of complications significantly and can cause permanent damage. AIM OF THE WORK The aim is to raise awareness for the effects of tamsulosin intake before cataract surgery. MATERIAL AND METHODS We conducted a critical review of publications on the association of IFIS in cataract surgery with alpha-receptor blockers. RESULTS AND DISCUSSION Tamsulosin has a risk of complications of up to 80 %, whereas doxazosin and alfuzosin only have a 15-20 % chance of complications. Tamsulosin therefore represents a significant risk factor for permanent secondary damage after cataract surgery. Even after discontinuing tamsulosin, IFIS was still observed after up to 3 years. Nevertheless, pausing of tamsulosin intake is recommended. An alternative preparation should therefore be preferred in patients who have not yet had cataract surgery. If patients are already pseudophakic, tamsulosin can be given without concern.
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Esen F, Bulut AE, Toker E. Efficacy and safety of low-concentration, bisulphite-containing, intracameral epinephrine and topical atropine treatments for the prevention of intraoperative floppy iris syndrome. Cutan Ocul Toxicol 2018; 37:286-290. [PMID: 29606019 DOI: 10.1080/15569527.2018.1456448] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE The aim of this study was to evaluate the efficacy and safety of topical atropine and topical atropine combined with intracameral low-concentration, bisulphite-containing epinephrine treatment for the prophylaxis of intraoperative floppy iris syndrome. MATERIALS AND METHODS Seventy-two eyes of 55 male patients who were treated with alpha-adrenergic antagonist medications for benign prostatic hyperplasia were included in this study. Standard premedication with topical cyclopentolate, phenylephrine, tropicamide and ketorolac was applied to all of the patients. In 22 cases no further prophylactic method was used (Group-NP), while in 29 cases topical atropine drops was instilled 12 h and 30 min before surgery (Group-A) and in 21 cases 1:16 000 epinephrine was injected to the anterior chamber at the beginning of surgery (Group-EA) in addition to topical atropine prophylaxis. RESULTS In Group-NP, 62.8% of the cases developed IFIS, while development of IFIS was significantly lower in Group-A (17.2%, p = 0.0004) and Group-EA (9.5%, p < 0.0001). Posterior capsule rupture was observed in two cases (9.1%) in Group-NP, in one case (3.4%) in Group-A and was not observed in Group-EA. There was no statistically significant difference between the groups for the development of surgical complications. We did not observe any adverse events or significant endothelial cell loss (p = 0.462). CONCLUSIONS Our results indicate that preoperative use of topical atropine reduces the incidence of IFIS. Use of low-concentration, bisulphite-containing epinephrine is more effective in the prevention of IFIS and does not cause preservative related endothelial damage. This prophylaxis may be preferred when preservative free epinephrine is not available.
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Affiliation(s)
- Fehim Esen
- a Department of Ophthalmology , Istanbul Medeniyet University School of Medicine , Istanbul , Turkey
| | | | - Ebru Toker
- c Department of Ophthalmology , Marmara University School of Medicine , Istanbul , Turkey
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Intraoperatives Floppy-Iris-Syndrom: ein aktueller Überblick. SPEKTRUM DER AUGENHEILKUNDE 2016. [DOI: 10.1007/s00717-016-0307-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Wahl M, Tipotsch-Maca SM, Vecsei-Marlovits PV. Intraoperative floppy iris syndrome and its association with various concurrent medications, bulbus length, patient age and gender. Graefes Arch Clin Exp Ophthalmol 2016; 255:113-118. [PMID: 27761703 DOI: 10.1007/s00417-016-3515-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 09/18/2016] [Accepted: 10/03/2016] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To evaluate the association between intraoperative floppy iris syndrome (IFIS) and concurrent medications containing selective alpha1A receptor antagonists as well as nonselective alpha1-adrenergic receptor antagonists, bulbus length, patient age and gender. METHODS We performed a prospective data acquisition of IFIS occurrence and grading, and retrospective evaluation of concurrent medications, bulbus length, patient age and gender of all patients undergoing cataract surgery over a 6-month period. RESULTS IFIS was observed in 119 of 947 cases (12.6 %). 31 of those 119 patients (26.1 %) had a concurrent medication with a drug that is associated with a higher risk of causing IFIS. Tamsulosin was the drug most commonly associated with IFIS (n = 11), followed by a combination of drugs (n = 7), doxazosin (n = 4), quetiapine (n = 4), finasterid (n = 2), prothipendyl (n = 2), and mianserin (n = 1). Bulbus length and age did not show any significant association with occurrence or grade of IFIS. Gender distribution among IFIS cases was 57.1 % males (n = 68) and 42.9 % (n = 51) females. CONCLUSIONS The occurrence of IFIS has to be expected with a variety of concurrent medications. The number of IFIS cases and the percentage of females in this series are higher compared to previous reports. The observations might be due to a rising awareness of surgeons or to an increasing number of causative medications on the market.
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Affiliation(s)
- Michael Wahl
- Department of Ophthalmology, Hietzing Hospital, Wolkersbergenstrasse 1, 1130, Vienna, Austria.,Karl Landsteiner Institute for Process Optimization and Quality Management in Cataract Surgery, Hietzing Hospital, Wolkersbergenstrasse 1, 1130, Vienna, Austria
| | - Saskia M Tipotsch-Maca
- Department of Ophthalmology, Hietzing Hospital, Wolkersbergenstrasse 1, 1130, Vienna, Austria.,Karl Landsteiner Institute for Process Optimization and Quality Management in Cataract Surgery, Hietzing Hospital, Wolkersbergenstrasse 1, 1130, Vienna, Austria
| | - Pia V Vecsei-Marlovits
- Department of Ophthalmology, Hietzing Hospital, Wolkersbergenstrasse 1, 1130, Vienna, Austria. .,Karl Landsteiner Institute for Process Optimization and Quality Management in Cataract Surgery, Hietzing Hospital, Wolkersbergenstrasse 1, 1130, Vienna, Austria.
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Prospective Masked Comparison of Intraoperative Floppy Iris Syndrome Severity with Tamsulosin versus Alfuzosin. Ophthalmology 2014; 121:829-34. [DOI: 10.1016/j.ophtha.2013.10.031] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Revised: 10/22/2013] [Accepted: 10/22/2013] [Indexed: 11/23/2022] Open
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Park HG, Choi S. Incidence and Risk Factors of Intraoperative Floppy Iris Syndrome During Cataract Surgery. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2014. [DOI: 10.3341/jkos.2014.55.1.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ho Gyun Park
- Department of Ophthalmology, Veterans Health Service Medical Center, Seoul, Korea
| | - Sangkyung Choi
- Department of Ophthalmology, Veterans Health Service Medical Center, Seoul, Korea
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Intraoperative floppy iris syndrome (IFIS) in patients receiving tamsulosin or doxazosin—a UK-based comparison of incidence and complication rates. Graefes Arch Clin Exp Ophthalmol 2013; 251:1541-5. [DOI: 10.1007/s00417-013-2260-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Revised: 12/30/2012] [Accepted: 01/03/2013] [Indexed: 11/26/2022] Open
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González Martín-Moro J, Muñoz Negrete F, Lozano Escobar I, Fernández Miguel Y. Intraoperative floppy-iris syndrome. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2013; 88:64-76. [PMID: 23433194 DOI: 10.1016/j.oftal.2011.09.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 07/07/2011] [Accepted: 09/11/2011] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Intraoperative-floppy iris syndrome (IFIS) has been recently described. It has been demonstrated that this new syndrome complicates cataract surgery. In this paper we have reviewed the syndrome, and offer practical information specially related to the origin and management of this syndrome and we offer practical information. MATERIAL AND METHODS A review of the related medical literature using PubMed and Cochrane databases. Combining the search terms tamsulosin, cataract, IFIS and intraoperative floppy iris syndrome, more than 200 articles were found. Eighty-two of them were obtained and analysed. In the remaining only the abstract could be studied. RESULTS The aetiological association between IFIS and tamsulosin (and to a lesser degree between IFIS and other alpha-antagonists) is well established. Other aetiological associations are doubtful. Most of the literature is centred on cataract surgery. However, a similar syndrome has been described during trabeculectomy. A possible association between these drugs and choroidal detachments has also been described. Undoubtedly tamsulosin treatment makes cataract surgery more difficult and increases the probability of intraoperative complications. Protocols to manage the syndrome have not yet been developed. Intracameral injection of alpha-adrenergic agonists seems to be useful. However there is no evidence of the usefulness of discontinuing the drug or using preoperative mydriatics. CONCLUSION The aetiological and clinic features of the syndrome are well established. More studies are needed to provide scientific evidence on the most appropriate way to cope with this syndrome.
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Altiaylik Ozer P, Altiparmak UE, Unlu N, Hazirolan DO, Kasim R, Duman S. Intraoperative Floppy-Iris Syndrome: Comparison of Tamsulosin and Drugs Other Than Alpha Antagonists. Curr Eye Res 2013; 38:480-6. [DOI: 10.3109/02713683.2013.763986] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Zaman F, Bach C, Junaid I, Papatsoris AG, Pati J, Masood J, Buchholz N. The floppy iris syndrome - what urologists and ophthalmologists need to know. Curr Urol 2012; 6:1-7. [PMID: 24917702 DOI: 10.1159/000338861] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2011] [Accepted: 08/06/2011] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Benign prostatic hyperplasia (BPH) and cataract formation are common in older people. Medical management of symptomatic BPH is often preferred to surgical treatment as surgery increases the risk of morbidities, whereas, surgery is the main form of treatment to restore sight in patient with cataract. The clinical treatment of BPH is either alpha-1 adrenergic antagonist alone or combination of alpha reductase inhibitor and alpha adrenergic receptor (AR) antagonist. There are four alpha-AR antagonists currently available to treat BPH. The uroselective alpha-blocker tamsulosin is the most commonly used drug among all. Studies showed that the majority of the patients who develop intraoperative floppy iris syndrome (IFIS) were on tamsulosin. Women are more likely to develop cataract than men and some recent studies showed that tamsulosin is effective in treating female lower urinary tract symptoms and thereby can cause IFIS during cataract surgery. EVIDENCE ACQUISITION We performed a critical review of the published articles and abstracts on association of IFIS with alpha-blockers and other medications as well as other medical conditions. EVIDENCE SYNTHESIS Tamsulosin is the most common cause of formation of IFIS. However, not all patients given tamsulosin develop IFIS and cases have been reported without any tamsulosin treatment. CONCLUSION Tamsulosin is a recognized cause to impede mydriasis and lead to IFIS during cataract surgery. Urologist should collaborate with their ophthalmology colleagues and general practitioner during prescribing tamsulosin in patients with history of cataract or waiting for planned cataract surgery. The increasing life expectancy and growth of older people will increase the number of men and women who suffer from lower urinary tract symptoms as well as cataract. Therefore, further research and studies are required to properly understand the relation of alpha blockers and IFIS.
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Affiliation(s)
- Faruquz Zaman
- Department of Urology, Barts and the London NHS Trust, London, UK
| | - Christian Bach
- Department of Urology, Barts and the London NHS Trust, London, UK
| | - Islam Junaid
- Department of Urology, Barts and the London NHS Trust, London, UK
| | | | - Jhumur Pati
- Department of Urology, Barts and the London NHS Trust, London, UK
| | - Junaid Masood
- Department of Urology, Barts and the London NHS Trust, London, UK
| | - Noor Buchholz
- Department of Urology, Barts and the London NHS Trust, London, UK
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Ku TK, Naseri A, Han Y, Porco TC, Rutar T. Effect of Timing and Duration of Tamsulosin Exposure on Complications in Resident-Performed Phacoemulsification. Ophthalmic Surg Lasers Imaging Retina 2011; 42:416-22. [DOI: 10.3928/15428877-20110602-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Accepted: 04/29/2011] [Indexed: 11/20/2022]
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Issa SA, Hadid OH, Baylis O, Dayan M. Alpha antagonists and intraoperative floppy iris syndrome: A spectrum. Clin Ophthalmol 2011; 2:735-41. [PMID: 19668424 PMCID: PMC2699798 DOI: 10.2147/opth.s2697] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background To determine occurrence of features of intraoperative floppy iris syndrome (IFIS) during cataract surgery in patients taking systemic alpha-antagonists (AA). Methods We prospectively studied patients on AA and who underwent phacoemulsification. The following were recorded: pupil diameter preoperatively, iris flaccidity, iris prolapse and peroperative miosis. Results We studied 40 eyes of 31 subjects. Mean age was 78 years. Overall, 14 eyes (13 patients) showed signs of IFIS: 9/13 (69%) eyes of patients on tamsulosin, 1/18 (6%) eyes in the doxazosin group, 2/2 prazosin patients, 1/4 eyes in the indoramin group, and 1/2 eyes in two patients on a combination of doxazosin and tamsulosin. Most cases (92%) had only one or two signs of IFIS. Bilateral cataract surgery was undertaken in 9 patients but only one patient (on tamsulosin) had features of IFIS in both eyes, while 4 patients (2 on tamsulosin and 2 on other AA) showed signs of IFIS in one eye only, and 4 patients did not show IFIS in either eye. Conclusion Most AA were associated with IFIS, but it tends to present as a spectrum of signs rather than full triad originally described. Tamsulosin was most likely to be associated with IFIS; however, its intake does not necessarily mean that IFIS will occur. For patients on AA, the behavior of the iris intraoperatively in one eye is a poor predictor of the other eye. Surgeons should anticipate the occurrence of IFIS in any patient on AA.
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Affiliation(s)
- Sharif A Issa
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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Chatziralli IP, Sergentanis TN. Risk Factors for Intraoperative Floppy Iris Syndrome: A Meta-Analysis. Ophthalmology 2011; 118:730-5. [PMID: 21168223 DOI: 10.1016/j.ophtha.2010.08.039] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Revised: 08/11/2010] [Accepted: 08/17/2010] [Indexed: 11/28/2022] Open
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Seth A, Truscott S, Chew J. Health supplement associated with intraoperative floppy-iris syndrome. J Cataract Refract Surg 2010; 36:1050-1. [DOI: 10.1016/j.jcrs.2010.03.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2009] [Indexed: 11/27/2022]
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Chen AA, Kelly JP, Bhandari A, Wu MC. Pharmacologic prophylaxis and risk factors for intraoperative floppy-iris syndrome in phacoemulsification performed by resident physicians. J Cataract Refract Surg 2010; 36:898-905. [DOI: 10.1016/j.jcrs.2009.12.039] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Revised: 12/15/2009] [Accepted: 12/15/2009] [Indexed: 10/19/2022]
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Neff KD, Sandoval HP, Fernández de Castro LE, Nowacki AS, Vroman DT, Solomon KD. Factors Associated with Intraoperative Floppy Iris Syndrome. Ophthalmology 2009; 116:658-63. [DOI: 10.1016/j.ophtha.2008.12.026] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2008] [Revised: 11/19/2008] [Accepted: 12/08/2008] [Indexed: 11/29/2022] Open
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Cantrell MA, Bream-Rouwenhorst HR, Steffensmeier A, Hemerson P, Rogers M, Stamper B. Intraoperative floppy iris syndrome associated with alpha1-adrenergic receptor antagonists. Ann Pharmacother 2008; 42:558-63. [PMID: 18364408 DOI: 10.1345/aph.1k679] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To describe intraoperative floppy iris syndrome (IFIS) in association with alpha(1)-adrenergic receptor (alpha(1)AR) antagonists by conducting a thorough literature review. DATA SOURCES Literature retrieval was accomplished by searching MEDLINE (2000-December 2007) using the terms intraoperative floppy iris syndrome (IFIS), adrenergic alpha-antagonist(s), tamsulosin, doxazosin, terazosin, and/or alfuzosin. In addition, reference lists from identified publications were reviewed to identify additional reports and studies of interest. STUDY SELECTION AND DATA EXTRACTION All articles in English identified from data sources were reviewed for relevance and uniqueness prior to inclusion. DATA SYNTHESIS IFIS was first described in 2005 as a clinical triad observed during cataract surgery that includes fluttering and billowing of the iris stroma, propensity for iris prolapse, and constriction of the pupil. IFIS increases the risk of complications during cataract surgery. Numerous reports have linked IFIS to use of alpha(1)AR antagonists, most notably tamsulosin, which is prescribed for benign prostatic hyperplasia. Tamsulosin blocks prostatic alpha(1A)ARs but may also selectively block alpha(1A)ARs in the iris dilator muscle, preventing mydriasis during cataract surgery. Other alpha(1)AR antagonists, including terazosin, doxazosin, and alfuzosin, have also been linked to IFIS; however, their relationship to the syndrome is not as definitive. When ophthalmologists are aware of a patient's previous alpha(1)AR antagonist exposure, specific steps can be taken to reduce the risk of surgical complications. Corrective measures used during surgery have included iris expansion hooks, intracameral phenylephrine, and preoperative atropine. CONCLUSIONS IFIS is a clinical syndrome observed during cataract surgery reported in patients taking systemic alpha(1)AR antagonists. It has been most strongly linked to use of tamsulosin. Medication washout periods of up to 2 weeks and specific surgical procedures have been attempted to reduce risk of complications from alpha(1)AR antagonists in the setting of cataract surgery. Patients should be educated regarding potential risks of this drug class so that they can discuss them with their healthcare providers, specifically ophthalmologists, prior to cataract surgery.
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Venkatesh R, Veena K, Gupta S, Ravindran RD. Intraoperative floppy iris syndrome associated with terazosin. Indian J Ophthalmol 2007; 55:395-6. [PMID: 17699957 PMCID: PMC2636019 DOI: 10.4103/0301-4738.33835] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Chang DF, Osher RH, Wang L, Koch DD. Prospective Multicenter Evaluation of Cataract Surgery in Patients Taking Tamsulosin (Flomax). Ophthalmology 2007; 114:957-64. [PMID: 17467530 DOI: 10.1016/j.ophtha.2007.01.011] [Citation(s) in RCA: 128] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Revised: 01/10/2007] [Accepted: 01/10/2007] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Intraoperative floppy iris syndrome (IFIS) caused by systemic alpha-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.
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Chadha V, Borooah S, Tey A, Styles C, Singh J. Floppy iris behaviour during cataract surgery: associations and variations. Br J Ophthalmol 2007; 91:40-2. [PMID: 16943229 PMCID: PMC1857591 DOI: 10.1136/bjo.2006.103036] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2006] [Indexed: 11/03/2022]
Abstract
AIM To assess the association of floppy iris behaviour during cataract surgery with use of alpha-1-antagonists and diabetes mellitus. METHODS 1842 eyes of 1786 patients undergoing phacohoemulsification surgery were prospectively enrolled. The use of commonly prescribed alpha-1-antagonists and the presence or absence of diabetes mellitus were noted. The occurrence of any of the features of the intraoperative floppy iris syndrome (IFIS) was noted by surgeons blinded to the patient's history. RESULTS 57% of patients receiving tamsulosin showed features of IFIS compared with 1% of the non-tamsulosin group (p<0.001). Of these, more than half the patients manifested the syndrome in an incomplete form. Only 1 of the 51 patients receiving other alpha-1-antagonists had IFIS. Diabetes was also not associated with IFIS (p = 1). CONCLUSIONS Tamsulosin is significantly associated with floppy iris behaviour during cataract surgery. But not all of these patients will necessarily show all or any features of IFIS. The floppy iris syndrome is likely to represent a continuum of severity. Various undefined factors, diabetes not being one of them, may have a contributory role. Non-selective alpha-1-antagonists are unlikely to be associated with IFIS.
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Affiliation(s)
- V Chadha
- Princess Alexandra Eye Pavilion, Chalmers Street, Edinburgh EH3 9HA, UK.
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Nguyen DQ, Sebastian RT, Kyle G. Surgeon's experiences of the intraoperative floppy iris syndrome in the United Kingdom. Eye (Lond) 2006; 21:443-4. [PMID: 17057648 DOI: 10.1038/sj.eye.6702616] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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