Alterations in Iris Structure and Pupil Size Related to Alpha-1 Adrenergic Receptor Antagonists Use: Implications for Floppy Iris Syndrome

Tufan, Hasan Ali; Gencer, Baran; Kara, Selçuk; Çömez, Arzu Taşkıran; Kurt, Hasan; Crozier, Alan

doi:10.1089/jop.2012.0151

Cited by 11 publications

(10 citation statements)

References 20 publications

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“…Although other studies using AS-OCT describe changes in iris thickness associated with tamsulosin use in patients with glaucoma, 8 similar to Tufan et al, 18 we did not detect differences in iris thickness in this study. In contrast to the differences in pupil size seen by Tufan et al on AS-OCT, 18 in our study photopic pupil measurements by AS-OCT were not significantly different between patients who had taken tamsulosin and those who had not.…”

Section: Discussioncontrasting

confidence: 50%

Effect of tamsulosin on iris vasculature and morphology

Shtein¹,

Hussain²,

Cooney³

et al. 2014

Journal of Cataract and Refractive Surgery

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PURPOSE To determine whether preoperative iris vasculature and morphology are altered in patients who have taken tamsulosin (Flomax). SETTING Academic multispecialty practice. DESIGN Case series. METHODS Patients with current or past tamsulosin use and age- and sex-matched control patients were included. Anterior segment optical coherence tomography (AS-OCT) and iris fluorescein angiography were performed to measure iris vasculature and thickness before cataract surgery. Data collected at surgery included pupil diameter, clinical signs of intraoperative floppy-iris syndrome, and surgical complications. RESULTS Tamsulosin was currently used by 16 patients and in the past by 4 patients; the control group comprised 10 patients. Pharmacologically dilated pupil diameter was significantly smaller preoperatively and immediately postoperatively in the tamsulosin group than in the control group (P = .009 and P = .003, respectively). There was a statistically significant decrease in pupil size intraoperatively in the tamsulosin group (P = .05) but not in the control group (P = .3). Iris-vasculature parameters, specifically time to first vessel fill and percentage of vessel fill on iris fluorescein angiography, were not significantly different between the 2 groups. The AS-OCT measurements of iris morphology were not statistically significantly different between the groups. No surgical complications occurred. No fluorescein dye leakage, staining, or other vascular anomalies were observed. CONCLUSIONS Although there were differences in pupil measurements and intraoperative iris behavior between patients who had been on tamsulosin and control patients, there were no significant differences in iris vasculature on iris fluorescein angiography or in iris morphology on AS-OCT.

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Section: Discussioncontrasting

confidence: 50%

Effect of tamsulosin on iris vasculature and morphology

Shtein¹,

Hussain²,

Cooney³

et al. 2014

Journal of Cataract and Refractive Surgery

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“…Shtein et al 14 used AS optical coherence tomography (AS-OCT) to assess iris morphology, including iris thickness and PD in patients using tamsulosin. Although some other studies using AS-OCT describe changes in iris thickness associated with tamsulosin use in patients with glaucoma, 8 similar to Tufan et al, 15 they did not detect differences in iris thickness in their study. In contrast to the differences in pupil size seen by Tufan et al 15 on AS-OCT, Shtein et al 14 found that photopic pupil measurements on AS-OCT were not significantly different between patients who had taken tamsulosin and those who had not.…”

Section: Discussionmentioning

confidence: 47%

“…Although some other studies using AS-OCT describe changes in iris thickness associated with tamsulosin use in patients with glaucoma, 8 similar to Tufan et al, 15 they did not detect differences in iris thickness in their study. In contrast to the differences in pupil size seen by Tufan et al 15 on AS-OCT, Shtein et al 14 found that photopic pupil measurements on AS-OCT were not significantly different between patients who had taken tamsulosin and those who had not. Their clinical measurements of pharmacologically dilated pupil size before surgery found significantly smaller pupils in patients who had used tamsulosin than in control patients, in contrast to the findings in a study by Cooney et al 16 They believed that their study used stronger pharmacologic pupil dilators because patients were being prepared for surgery rather than being dilated in the clinic.…”

Section: Discussionmentioning

confidence: 47%

Evaluation of Anterior Segment Changes of Patients Taking Alpha1-Blockers by Ultrasound Biomicroscopy in the Drug-free Period

Acar¹,

Eltutar²,

Zırtıloğlu³

2017

tjo

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Objectives:To evaluate and compare anterior segment changes in patients taking alpha-1 (α1) blockers (tamsulosin, terazosin, doxazosin, alfuzosin) for benign prostatic hypertrophy, during drug intake and drug-free period, using ultrasound biomicroscopy (UBM).Materials and Methods:In this prospective study, UBM was done before and after pupil dilatation in 31 phakic eyes of 19 male patients taking α1-blockers. Undilated and dilated UBM was repeated before cataract extraction, after stopping the drug for 10 days. On ideal images, pupil diameter (PD), anterior chamber depth (ACD), anterior chamber angle (ACA), and angle opening distances at points 500 µm and 250 µm from the scleral spur (AOD500 and AOD250) values were noted and changes in parameters were evaluated to reveal any changes that occurred after discontinuing the drug. No patient in the study was previously or currently using any other α1-adrenergic antagonist medication. Exclusion criteria for all patients included a history of diabetes mellitus, systemic hypertension, glaucoma, pseudoexfoliation syndrome, chronic use of medicated eye drops, and previous ocular surgery.Results:PD, ACD, ACA, AOD500 and AOD250 values measured before pupil dilatation in the drug-free period were not significantly different from those measured during α-blocker intake (p>0.05). In dilated eyes, the mean value of AOD500 was 0.35±0.08 mm during drug usage and 0.39±0.08 mm in the drug-free period. The mean value of AOD250 was 0.23±0.06 mm during drug usage and 0.26±0.07 mm after discontinuation. These increments were statistically significant (p<0.05, z=-3.699, z=-2.984). On the other hand, there were no significant differences in ACD, ACA, or PD values in dilated eyes after discontinuing α1-blockers (p>0.05).Conclusion:The interruption of taking α1-blockers in patients who have benign prostatic hypertrophy does not seem to influence anterior segment parameters generally. However, further investigation is needed.

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“…One study on rabbits 14 reported that a 1 -A adrenoceptors were the major type in the iris, 14 and another 15 reported that these receptors were responsible for sympathetically evoked mydriasis in pentobarbital-anesthetized rabbits. Other studies 16,17 have reported morphologic changes in patients treated with tamsulosin; these changes may predispose the prolapse of the iris during cataract surgery. When the iris prolapses during phacoemulsification cataract surgery, the surgeon can create a longer wound, which might be associated with postoperative wound dehiscence.…”

Section: Discussionmentioning

confidence: 93%

Wound Dehiscence as a Cataract Surgery–Associated Postoperative Complication in Patients Previously Treated With Alpha-1 Blocker Tamsulosin—A Population-Based Study in Taiwan

Hsiao

Liao

et al. 2014

American Journal of Ophthalmology

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Alterations in Iris Structure and Pupil Size Related to Alpha-1 Adrenergic Receptor Antagonists Use: Implications for Floppy Iris Syndrome

Abstract: Evaluating PD alterations might be more useful than evaluating iris structural alterations in predicting IFIS. There is still a need for a reliable method that will determine the possibility of IFIS.

Cited by 11 publications

References 20 publications

Effect of tamsulosin on iris vasculature and morphology

Effect of tamsulosin on iris vasculature and morphology

Evaluation of Anterior Segment Changes of Patients Taking Alpha1-Blockers by Ultrasound Biomicroscopy in the Drug-free Period

Wound Dehiscence as a Cataract Surgery–Associated Postoperative Complication in Patients Previously Treated With Alpha-1 Blocker Tamsulosin—A Population-Based Study in Taiwan

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