Alpha antagonists and intraoperative floppy iris syndrome: A spectrum

Sharif A Issa, Omar H Hadid, Oliver Baylis, Margaret Dayan, Sharif A Issa, Omar H Hadid, Oliver Baylis, Margaret Dayan

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.

Keywords: alpha antagonist; alpha blocker; cataract surgery; intraoperative floppy iris syndrome; tamsulosin.

Figures

Figure 1
Figure 1
Alpha-blockers and intraoperative floppy iris syndrome surgeon questionnaire.
Figure 2
Figure 2
Incidence of intraoperative floppy iris syndrome (IFIS) with different alpha antagonists.

References

    1. Altan-Yaycioglu R, Yaycioglu O, Gul U, et al. The effects of two systemic alpha1-adrenergic blockers on pupil diameter: a prospective randomized single-blind study. Naunyn Schmiedebergs Arch Pharmacol. 2007;375:199–203.
    1. Chadha V, Borooha S, Tey A, et al. Floppy iris behaviour during cataract surgery: associations and variations. Br J Ophthalmol. 2007;91:40–2.
    1. Chang DF, Campbell JR. Intraoperative floppy iris syndrome associated with tamsulosin. J Cataract Refract Surg. 2005a;31:664–73.
    1. Chang DF, Campbell JR. Reply: Intraoperative floppy iris syndrome associated with tamsulosin [letter] J Cataract Refract Surg. 2005b;31:2241.
    1. Chang DF, Osher RH, Wang L, et al. Prospective multicenter evaluation of cataract surgery in patients taking tamsulosin (flomax) Ophthalmology. 2007;114:957–64.
    1. Manvikar S, Allen D. Cataract surgery management in patients taking tamsulosin staged approach. J Cataract Refract Surg. 2006;32:1611–14.
    1. 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;372:346–53.
    1. Muqit MM, Menage MJ. Intraoperative floppy iris syndrome [letter] Ophthalmology. 2006;113:1885–6.
    1. Nguyen DQ, Sebastian RT, Kyle G. Surgeon’s experiences of the intra-operative floppy iris syndrome in the United Kingdom. Eye. 2007;21:443–4.
    1. Parssinen O. The use of tamsulosin and iris hypotony during cataract surgery. Acta Ophthalmol Scand. 2005;83:624–6.
    1. Schwinn DA, Afshari NA. α1-Adrenergic antagonists and floppy iris syndrome: tip of the iceberg? Am J Ophthalmol. 2005;112:2059–60.
    1. Schwinn DA, Afshari NA. Alpha(1)-Adrenergic receptor antagonists and the iris: new mechanistic insights into floppy iris syndrome. Surv Ophthalmol. 2006;51:501–12.
    1. Settas G, Fitt AW. Intraoperative floppy iris syndrome in a patient taking alfuzosin for benign prostatic hypertrophy. Eye. 2006;20:1431–2.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa