Clinical risk factors associated with intraoperative floppy iris syndrome: a prospective study

Abstract

The findings suggest that finasteride use and aging are risk factors for IFIS and confirm the association of tamsulosin use with IFIS. Further, doxazosin appears to be a relatively safe drug with respect to the occurrence of IFIS.

<p>Intraoperative Floppy Iris Syndrome: Updated Perspectives</p>

“…8 In addition, several neuromodulators including benzodiazepines, donepezil and duloxetine have been associated with IFIS by several studies. 5,7,33,34 In a large retrospective study, Chatziralli et al reported an increased incidence of IFIS in patients receiving benzodiazepines, an association that was confirmed in a univariate analysis by Kaczmarek et al 5,7 In 2007 Papadopoulos et al reported IFIS in a patient with long history (8 years) of donepezil intake for Alzheimer's disease, while recently González-Martín -Moro et al published a case of IFIS in a patient receiving duloxetine as antidepressant for 3 years. 33,34 The increased incidence of IFIS in patients treated with the abovementioned medications might be either causative or coincidental.…”

“…The appearance of intraoperative floppy iris syndrome has been shown to be affected by many reasons and various systemic medications. [5][6][7][8][9][10] However, IFIS came in the spotlight when the therapeutic algorithm for the treatment of benign prostatic hyperplasia (BPH) suggested the intake of a1-ARA as the first line treatment, substituting surgical intervention. 13 Three subtypes of a1-adrenergic receptors (a1-AR) have been identified so far: a1 A , a1 B and a1 D .…”

“…16 Other systemic medication such as benzodiazepines, antipsychotics and hypertension drugs may have a similar effect on the iris, although the exact pathophysiological mechanism has not been fully understood and the correlation with IFIS incidence does not seem to be as strong as with tamsulosin. 4,5,7 Cataract surgery is one of the most frequently performed surgeries worldwide. 18 Similarly, BHP is present in almost 50% of men by the age of 50 years and 75% of men by the age of 80 years.…”

“…Regarding gender, a strong positive correlation has been found between IFIS and male sex. 5,7,9,40 The significantly higher prevalence of IFIS among men, can obviously be attributed to the intake of a1-ARAs for BHP treatment. IFIS however, occurs in females too, although less commonly than in males, thus women are unfortunately often overlooked as high-risk candidates for IFIS development.…”

“…Beyond the original correlation with tamsulosin intake, 1 IFIS has been correlated with several risk factors which include: gender, age, hypertension, other a1-adrenergic receptor antagonists (a1-ARAs), finasteride, angiotensin II receptor inhibitors, benzodiazepines, antipsychotics, hypertension drugs and decreased dilated pupil diameter. [5][6][7][8][9][10] The careful preoperative assessment of these predisposing factors is essential in the stratification of the preoperative risk. As a matter of fact, IFIS is associated with higher rate of complications, that include increased ocular inflammation, posterior capsule rupture, anterior capsule tears, vitreous loss, iris trauma, cystoid macular edema and hyphema.…”