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Intraoperative floppy iris syndrome (IFIS) in patients receiving tamsulosin or doxazosin—a UK-based comparison of incidence and complication rates

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Abstract

Background

The association between intraoperative floppy iris syndrome (IFIS) and tamsulosin has been well-described. The rate of IFIS in association with other α-1 antagonists needs further clarification. The objective of this study was to determine the incidence of IFIS and associated cataract surgery complications in patients taking tamsulosin or doxazosin.

Methods

Patients receiving tamsulosin or doxazosin, and an equivalent number of controls, were identified using the electronic patient record for cataract surgery performed over 2 years. The presence of IFIS and intraoperative complications were ascertained. Modifications of surgical technique in the form of preoperative 1 % atropine, intraoperative diluted phenylephrine, iris hooks, or highly viscous viscoelastic materials were recorded.

Results

Of the 2,785 cataract operations performed in 2,028 patients, 52 cases (1.9 %) were on tamsulosin and 109 were on doxazosin (3.9 %). In the doxazosin group (excluding three cases with incomplete data), significantly more eyes (17 of 106 eyes, 16 %) showed at least one IFIS characteristic than controls, six eyes (6 %) required adjustment of surgical technique, and intraoperative complications occurred in two eyes (1.9 %). In the tamsulosin group, significantly more eyes (25 of 52 eyes, 48 %) demonstrated at least one IFIS feature than control or doxazosin eyes; 18 eyes (35 %) needed adjustment of surgical technique, and seven (13.5 %) suffered intraoperative complications.

Conclusion

Incidence of IFIS was significantly higher in tamsulosin and doxazosin patients. The presence of IFIS was associated with a significantly higher complication rate. We would advise that all patients receiving α1 antagonists (not only those receiving tamsulosin) should be identified preoperatively, receive appropriate modifications in preparation, and have alternative techniques and a senior surgeon available at the time of surgery.

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References

  1. Chang DF, Campbell JR (2005) Intraoperative floppy iris syndrome associated with tamsulosin. J Cataract Refract Surg 31:664–673

    Article  PubMed  Google Scholar 

  2. Oshika T, Ohashi Y, Inamura M, Ohki K, Okamoto S, Koyama T, Sakabe I, Takahashi K, Fujita Y, Miyoshi T, Yasuma T (2007) Incidence of intraoperative floppy iris syndrome in patients on either systemic or topical α1-adrenoceptor antagonist. Am J Ophthalmol 143:150–151

    Article  PubMed  Google Scholar 

  3. Cheung CM, Awan MA, Sandramouli S (2006) Prevalence and clinical findings of tamsulosin-associated intraoperative floppy iris syndrome. J Cataract Refract Surg 32:1336–1339

    Article  PubMed  Google Scholar 

  4. Chang DF, Osher RH, Wang L, Koch DD (2007) Prospective multicenter evaluation of cataract surgery in patients taking tamsulosin (Flomax). Ophthalmology 114(5):957–964

    Article  PubMed  Google Scholar 

  5. Nguyen DQ, Sebastian RT, Kyle G (2007) Surgeon’s experiences of the intraoperative floppy iris syndrome in the United Kingdom. Eye 21:443–444

    Article  PubMed  CAS  Google Scholar 

  6. Chadha V, Borooah S, Tey A, Styles C, Singh J (2007) Floppy iris behaviour during cataract surgery: associations and variations. Br J Ophthalmol 91:40–42

    Article  PubMed  CAS  Google Scholar 

  7. Roehrborn CG, Schwinn DA (2004) Alpha1-adrenergic receptors and their inhibitors in lower urinary tract symptoms and benign prostatic hyperplasia. J Urol 171(3):1029–1035

    Article  PubMed  CAS  Google Scholar 

  8. Wikberg-Matsson A, Uhlen S, Wikberg JE (2000) Characterization of α(1)- adrenoceptor subtypes in the eye. Exp Eye Res 70:51–60

    Article  PubMed  CAS  Google Scholar 

  9. Goseki T, Ishikawa H, Ogasawara S, Mashimo K, Nemoto N, Taguchi Y, Yago K, Shimizu K (2012) Effects of tamsulosin and silodosin on isolated albino and pigmented rabbit iris dilators: possible mechanism of intraoperative floppy-iris syndrome. J Cataract Refract Surg 38(9):1643–1649

    Article  PubMed  Google Scholar 

  10. Schwann DA, Afshari NA (2005) Alpha1-adrenergic antagonists and floppy iris syndrome: tip of the iceberg? Ophthalmology 112:2059–2060

    Article  Google Scholar 

  11. El-Ghatit AM (2006) Association of IFIS and vasodepressor medication [letter]. J Cataract Refract Surg 32:546–547

    Article  PubMed  Google Scholar 

  12. Settas G, Fitt AW (2006) Intraoperative floppy iris syndrome in a patient taking alfuzosin for benign prostatic hypertrophy [letter]. Eye 20:1431–1432

    Article  PubMed  CAS  Google Scholar 

  13. Muqit MM, Menage MJ (2006) Intraoperative floppy iris syndrome [letter]. Ophthalmology 113:1885–1886

    Article  PubMed  Google Scholar 

  14. Schwinn DA, Afshari NA (2006) Alpha(1)-adrenergic receptor antagonists and the iris: new mechanistic insights into floppy iris syndrome. Surv Ophthalmol 51:501–512

    Article  PubMed  Google Scholar 

  15. Parmar B, Qatarneh D, Claoué C (2005) Alpha antagonists in cataract surgery [letter]. J Cataract Refract Surg 31:2241

    Article  PubMed  Google Scholar 

  16. Issa SA, Hadid OH, Baylis O, Dayan M (2008) Alpha antagonists and intraoperative floppy iris syndrome: a spectrum. Clin Ophthalmol 2:735–741

    Article  PubMed  Google Scholar 

  17. Altan-Yaycioglu R, Gedik S, Pelit A, Akova YA, Akman A (2009) Clinical factors associated with floppy iris signs: a prospective study from two centers. Ophthalmic Surg Lasers Imaging 40:232–238

    Article  PubMed  Google Scholar 

  18. Pérez-Silguero D, Ramallo-Fariña Y, Pérez-Silguero MA, Jimenez-Garcia A, Penate-Valdivieiso S, Perez-Hernandez FR (2009) Comparison of the effectiveness of two different pharmacological approaches to prevent floppy iris syndrome [in Spanish]. Arch Soc Esp Oftalmol 84:549–556

    PubMed  Google Scholar 

  19. Parssinen O, Leppanen E, Keski-Rahkonen P, Mauriala T, Dugue B, Lehtonen M (2006) Influence of tamsulosin on the iris and its implications for cataract surgery. Invest Ophthalmol Vis Sci 47:3766–3771

    Article  PubMed  Google Scholar 

  20. Cantrell MA, Bream-Rouwenhorst HR, Steffensmeier A, Hemerson P, Rogers M, Stamper B (2008) Intraoperative floppy iris syndrome associated with alpha 1-adrenergic receptor antagonists. Ann Pharmacother 42:558–563

    Article  PubMed  CAS  Google Scholar 

  21. Chatziralli IP, Sergentanis TN (2011) Risk factors for intraoperative floppy iris syndrome: a meta-analysis. Ophthalmology 118:730–735

    Article  PubMed  Google Scholar 

  22. Takmaz T, Can I (2007) Clinical features, complications, and incidence of intraoperative floppy iris syndrome in patients taking tamsulosin. Eur J Ophthalmol 17:909–913

    PubMed  CAS  Google Scholar 

  23. Intraoperative floppy iris syndrome (IFIS) associated with systemic alpha-1 blockers. ASCRS and AAO Educational Update Statement (Press Release). http://www.ascrs.org/press_releases/loader.cfm?csModule=security/getfile&pageid=13342. Date of access:2009

  24. Chang DF, Braga-mele R, Mamalis N, Masket S, Miller KM, Nichamin LD, Packard RB, Packer M, ASCRS Cataract Clinical Committee (2008) Clinical experience with intraoperative floppy-iris syndrome. Results of the 2008 ASCRS member survey. J Cataract Refract Surg 34:1201–1209

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Ophthalmology Department, Hinchingbrooke Healthcare NHS Trust, Huntingdon, UK

    Anjana Haridas, Marina Syrimi, Basel Al-Ahmar & Melanie Hingorani

  2. 1 Old School Lane, Upware, Ely, Cambridgeshire, CB7 5ZR, UK

    Anjana Haridas

Authors
  1. Anjana Haridas
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  2. Marina Syrimi
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  3. Basel Al-Ahmar
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  4. Melanie Hingorani
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Correspondence to Anjana Haridas.

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The authors have full control of all primary data, and we agree to allow Graefe's Archive for Clinical and Experimental Ophthalmology to review our data upon request.

The authors do not have any proprietary interest in this study.

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Haridas, A., Syrimi, M., Al-Ahmar, B. et al. Intraoperative floppy iris syndrome (IFIS) in patients receiving tamsulosin or doxazosin—a UK-based comparison of incidence and complication rates. Graefes Arch Clin Exp Ophthalmol 251, 1541–1545 (2013). https://doi.org/10.1007/s00417-013-2260-4

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  • DOI: https://doi.org/10.1007/s00417-013-2260-4

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