Intraoperative Floppy Iris Syndrome Associated with α₁-Adrenergic Receptor Antagonists

Abstract

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.

Urologic medications and ophthalmologic side effects: a review

“…Subsequent reports, similar to our own, have shown that terazosin, doxazosin and alfuzosin can be related to IFIS. 16,17 It is likely that the entire class of alpha-blockers can cause IFIS. However, the syndrome seems to be less common and less severe with others as compared to when tamsulosin is used.…”

Pathophysiology and Pre-Operative Evaluation of Patients at Risk for Intraoperative Floppy Iris Syndrome (IFIS)

“…The increased 1A AR selectivity of the third-generation "uroselective" agents tamsulosin and silodosin is postulated to provide additional relief of LUTS in patients with BPH without increasing the rate of serious adverse cardiovascular effects due to systemic AR antagonism. (Cantrell et al, 2008;Cantrell et al, 2010) 1 AR antagonists not only therapeutically inhibit prostatic 1 AR but may also selectively antagonize these receptors in the iris dilator muscle. In the iris, 1A AR mediate iris dilator smooth muscle contraction whereas iris arteriolar contraction is mediated via 1B AR.…”

Benign prostatic hyperplasia: clinical treatment can complicate cataract surgery

“…Tamsulosin is the most antagonists. Tamsulosin is the most Tamsulosin is the most uroselective alpha-1AAR antagonist approved for use alpha-1AAR antagonist approved for use antagonist approved for use in the treatment of symptomatic BPH, which, although it improves urinary outflow, is also thought to inhibit the iris dilator smooth muscles causing varying degrees of IFIS (7)(8)(9). The effectiveness of tamsulosin is similar to other alpha-1AAR blocker drugs.…”

“…This may relate to differences in receptor affinity with tamsulosin and with other related medications. It is believed that tamsulosin is more highly selective for alpha-1AAR antagonists than alpha-1AAR antagonists than antagonists than other alpha-1AAR blocker drugs (8). These particular alpha-1AAR blocker drugs (8).…”

“…It is believed that tamsulosin is more highly selective for alpha-1AAR antagonists than alpha-1AAR antagonists than antagonists than other alpha-1AAR blocker drugs (8). These particular alpha-1AAR blocker drugs (8). These particular blocker drugs (8).…”