Ten Years of Intraoperative Floppy Iris Syndrome in the Era of α-blockers

Overview

Journal Cent European J Urol

Specialty Urology

Date 2018 May 8

PMID 29732214

Citations 10

Authors

Andreas Lunacek

Badereddin Mohamad Al-Ali

Christian Radmayr

Maria Weber

Wolfgang Horninger

Oliver Findl

Eugen Plas

Affiliations

Soon will be listed here.

Abstract

Introduction: The use of alpha-1 receptor antagonists in the treatment of benign prostatic hyperplasia (BPH) has created a problem in ophthalmic surgery, the so-called intraoperative floppy iris syndrome (IFIS). This consists of a billowing iris, insufficient pupillary dilation with progressive intraoperative miosis, and protrusion of iris tissue through the tunnel and side port incision that are made for access to the anterior chamber during surgery. IFIS presents particular difficulties in cataract surgery which is carried out through the pupil with manipulations in the immediate vicinity of the iris. The complications range from poor visibility of the operative field to iris damage with the surgical instruments and to rupture of the posterior capsule, with loss of lens material into the vitreous body.

Material And Methods: A comprehensive literature review was performed using MEDLINE with MeSH terms and keywords 'benign prostatic hyperplasia', 'intraoperative floppy iris syndrome', 'adrenergic alpha-antagonist' and 'cataract surgery'. In addition, reference lists from identified publications were reviewed to identify reports and studies of interest from 2001 to 2017.

Results: The A total of 95% of experienced ophthalmologic surgeons reported that systematic treatment with tamsulosin represents a challenging surgical condition increasing the risk of complications. Alpha-blockers are commonly prescribed, with 1,079,505 packages of tamsulosin prescribed each month in 2014 in Austria. Dose modification may be one way to reduce the risk of IFIS. A lower incidence of IFIS was reported in patients on tamsulosin in Japan, but the recommended dosage was lower than that used in Europe and the US (0.2 mg vs. 0.4 mg).

Conclusions: We showed that not all patients taking tamsulosin experience IFIS. Moreover, larger investigations with a prospective design are needed, including studies to monitor the pre- and post-therapeutic ophthalmologic changes under tamsulosin, as well as urodynamic improvements resulting from this therapy.

Citing Articles

Intraoperative Iris Behavior during Phacoemulsification Maneuvers in Rabbits Treated with Selective α1-Blocker, 5α-Reductase Inhibitor, or Anxiolytic Medication.

Horvath K, Vultur F, Voidazan S, Simon V, Rusu A J Pers Med. 2024; 14(8).

PMID: 39202031 PMC: 11355255. DOI: 10.3390/jpm14080840.

Prospective analysis of anatomic features predisposing patients to intraoperative floppy iris syndrome.

Paschon K, Szegedi S, Weingessel B, Fondi K, Huf W, Vecsei-Marlovits P Graefes Arch Clin Exp Ophthalmol. 2023; 262(1):103-111.

PMID: 37428221 DOI: 10.1007/s00417-023-06165-3.

Floppy iris syndrome associated with specific medication intake: A narrative review.

Maluskova M, Vidlar A, Maresova K, Lounova V, Karhanova M Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2022; 167(1):9-15.

PMID: 36196652 DOI: 10.5507/bp.2022.042.

Finasteride and Floppy Iris Syndrome: What Role Can the Dermatologist Play?.

Calvao J, Feijao J, Soares R Int J Trichology. 2022; 14(3):115-116.

PMID: 35755965 PMC: 9231532. DOI: 10.4103/ijt.ijt_118_20.

Comparison of effects of tamsulosin and silodosin on subfoveal choroidal thickness and pupil size diameters in patients with prostatic hyperplasia.

Kanar H, Olcucu M, Ozdemir I Int Ophthalmol. 2021; 41(12):3921-3927.

PMID: 34319502 DOI: 10.1007/s10792-021-01961-4.

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