Intraoperative floppy-iris syndrome associated with α1-adrenoreceptors

Abstract

Men exposed to tamsulosin had a significantly higher risk for developing IFIS than men exposed to alfuzosin. Intraoperative floppy-iris syndrome significantly increased the complication rate of cataract surgery.

Pharmacologic pupil dilation as a predictive test for the risk for intraoperative floppy-iris syndrome

“…Our results agree with those in the literature, in which the reported incidence of IFIS ranges from 43% to 100% in patients treated with tamsulosin. 1,2,4,15,28 The greater incidence and severity of IFIS in our tamsulosin group than in the other a1-ARA group is supported by the findings in the ASCRS survey 21 and is in agreement with the hypothesis that the systemic use of less selective a 1A -subtype antagonists leads to a lower prevalence of IFIS. 1,15,28,29 A recent study from Canada 4 reports an adjusted odds ratio of 32 for IFIS in patients exposed to tamsulosin compared with those exposed to alfuzosin.…”

“…24 As stated, IFIS can increase the risk for intraoperative complications if not identified and managed early in otherwise uncomplicated cataract surgery. 1,3,4 The importance of predicting IFIS before phacoemulsification becomes evident when reviewing surgical complications in the peer-reviewed literature. Early retrospective studies of IFIS showed posterior capsule rupture rates of 7% 13 to 12%.…”

“…3 The latter involves a high rate of intraoperative complications, such as iris trauma, zonular dehiscence, posterior capsule rupture, and vitreous loss, as well as postoperative complications, including intraocular pressure (IOP) elevation and cystoid macular edema (CME). 1,2,4 A poorly dilating pupil is not an uncommon finding during cataract surgery and may have various causes, including glaucoma, diabetes, and pseudoexfoliation, while iris prolapse into the phaco tunnel can be caused by elevated IOP. 5 However, in IFIS patients, the clinical characteristics of the iris during cataract surgery typically differ, mainly due to the hypotonically fluttering iris during irrigation/aspiration (I/A).…”

Ophthalmic manifestations of urological drugs

“…A retrospective study from Canada found the incidence of IFIS to be 86% in tamsulosin-treated patients compared to 15% in patients on alfuzosin. 4 However, while the incidence of IFIS in the general population has been reported to be between 0.6 and 3.7%, reports on the incidence of IFIS in patients exposed to tamsulosin vary widely from 37.9% to 100%. 3,[5][6][7][8][9] IFIS has been found to be associated with other alpha-blockers including doxazocin, although much less strongly.…”

Management of Intraocular Floppy Iris Syndrome (IFIS) in Cataract Surgery

“…However, tamsulosin also has a very high affinity for the α-1a and α-1d ARs in the smooth muscular tissue of the iris. On the other hand, alfuzosin acts clinically in a more uro-selective manner, which may explain, why alfuzosin causes IFIS less frequent than tamsulosin, decreasing the odd ratio for IFIS to 1:32 compared to patients exposed to tamsulosin (Blouin et al 2007). …”