Incidence of Intraoperative Floppy Iris Syndrome in Patients on Either Systemic or Topical α1-Adrenoceptor Antagonist

Department of Ophthalmology, University of Tsukuba, Tsukuba, Ibaraki, Japan
American Journal of Ophthalmology (Impact Factor: 4.02). 02/2007; 143(1):150-1. DOI: 10.1016/j.ajo.2006.07.046
Source: PubMed

ABSTRACT To evaluate the incidence of Intraoperative Floppy Iris syndrome (IFIS) in relation to the usage of alpha(1)-adrenoceptor antagonists.
Prospective, interventional case series.
In 2,643 consecutive eyes of 1,968 patients undergoing cataract surgery, occurrence of IFIS and use of alpha(1) antagonists were recorded.
IFIS was observed in 29 eyes (1.1%) of 25 male patients, all of whom were receiving alpha(1) antagonists. In those receiving systemic tamsulosin, alpha(1A) selective antagonist, IFIS developed in 25 (43.1%) of 58 eyes. In those receiving systemic naftopidil, alpha(1A) and alpha(1D) antagonists, IFIS was found in 4 (19.0%) of 21 eyes. There was no case of IFIS in patients who received other systemic alpha(1) antagonists and in eyes treated with bunazosin eyedrops, a nonselective alpha(1) antagonist.
IFIS occurred in 1.1% of cases treated with systemic alpha(1A)-adrenoceptor antagonists for benign prostatic hypertrophy. Topical nonselective alpha(1) antagonist did not induce IFIS.

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    • "erall incidence in cataract sur - gery is 2% , whereas it was reported to be encoun - tered in 63% of men with BPH receiving the α 1A - adrenoceptor antagonist tamsulosin [ Chang and Campbell , 2005 ] . Oshika and col - leagues reported the prevalence of IFIS and the association between α 1 antagonists and IFIS in men undergoing cataract surgery [ Oshika et al . 2007 ] ."
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    ABSTRACT: Naftopidil, which to a certain extent shows an affinity to α1D-adrenoceptor subtype in addition to a high affinity to α1A-adrenoceptor, has been used for the treatment of benign prostatic obstruction and benign prostatic hyperplasia (BPH) associated lower urinary tract symptoms (LUTS). The aim of the present review is to systematically refer to the published studies on this unique agent for BPH. Based on a randomized prazosin-controlled study and another double-blind placebo-controlled study, which verified the dose-dependent effects of naftopidil, the Japanese Ministry of Health, Labor and Welfare approved naftopidil for treating men with BPH in 1996. Several tamsulosin-controlled studies have suggested treatment effects of naftopidil similar to those of tamsulosin and potentially higher efficacy for alleviating storage symptoms by naftopidil. Although well-designed, randomized studies are warranted to confirm the long-term outcomes and effector/target of naftopidil, the α1A-antagonist naftopidil, which also blocks α1D-adrenoceptor, improves voiding symptoms, and may also be useful for the management of men with storage symptoms represented by nocturia, retrieving their quality of life impaired by BPH-associated LUTS.
    Therapeutic Advances in Urology 04/2013; 5(2):111-9. DOI:10.1177/1756287212461681
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    • "The prevalence of IFIS in patients undergoing phacoemulsification varies among different countries, from 0.5– 1.6% in the UK (Cheung et al. 2006; Chadha et al. 2007), 1.1% in Japan (Oshika et al. 2007), 1.6% in Turkey (Takmaz & Can 2007) to 2.0% in the USA (Chang & Campbell 2005). The incidence of IFIS in patients with cataract treated with the systemic a-1 a AR antagonist tamsulosin ranges from 43% to 100% (Chang & Campbell 2005; Parssinen 2005; Blouin et al. 2007; Chadha et al. 2007; Oshika et al. 2007). "
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    ABSTRACT: Intraoperative floppy iris syndrome (IFIS) during cataract surgery is characterized by iris fluttering, iris prolapse towards the incisions, and a progressive pupillary constriction leading to high rates of complications. The syndrome has been reported following the treatment of benign prostatic hyperplasia with α-1(a) adrenergic receptor inhibitors, especially tamsulosin. The present paper describes the syndrome and discusses its pharmacological background. Several techniques to prevent and to deal with the syndrome are presented.
    Acta ophthalmologica 07/2009; 87(7):704-8. DOI:10.1111/j.1755-3768.2008.01442.x · 2.51 Impact Factor
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    • "The overall incidence of IFIS among patients undergoing cataract surgery is 1.1–2.3%, but 37.9–73.0% in patients receiving tamsulosin (Chang & Campbell 2005; Blouin et al. 2007; Chadha et al. 2007; Oshika et al. 2007). "
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    ABSTRACT: To determine the risk ratios and incidence of intraoperative floppy iris syndrome (IFIS) during cataract surgery in patients using tamsulosin, and to assess management strategies for IFIS. We performed a non-randomized, observational, prospective study, in which 594 eyes of 579 patients undergoing cataract surgery were enrolled. Surgeons were masked to the patients' drug history. Usage or non-usage of tamsulosin, duration of tamsulosin use, presence or absence of IFIS, management of IFIS and intraoperative complications were recorded in the patients' theatre notes. Twelve of 15 (80%) IFIS patients were taking systemic tamsulosin. Twelve of 23 (52%) patients using tamsulosin showed features of IFIS. The odds ratios (ORs) and relative risk (RR) ratios show strong positive correlations between tamsulosin use and IFIS. The ORs and RR ratios and the 95% confidence intervals (CIs) are as follows: OR 206.5 (95% CI 50.9-836.5); RR 99.3 (95% CI 30.0-327.8). There were no statistically significant differences between patients with or without IFIS, who were using tamsulosin, in terms of age or duration of tamsulosin use (p > 0.05). Seven eyes (46.6%) with IFIS were successfully managed with epinephrine. Eight eyes (53.4%) with IFIS needed iris hooks. Patients using tamsulosin appear to be at high risk of IFIS during cataract surgery. The occurrence of IFIS may not be affected by duration of tamsulosin use or age. Epinephrine may be effective in approximately 50% of eyes with IFIS. The iris hook procedure represents an effective management strategy in IFIS.
    Acta ophthalmologica 05/2008; 87(3):306-9. DOI:10.1111/j.1755-3768.2008.01246.x · 2.51 Impact Factor
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