Alpha-Blockers and Intraoperative Floppy Iris Syndrome: Ophthalmic Adverse Events Following Cataract Surgery

Abstract

Intraoperative floppy iris syndrome (IFIS) is a triad of progressive intraoperative miosis despite preoperative dilation, billowing of a flaccid iris, and iris prolapse toward the incision sites during phacoemulsification surgery for cataract removal. IFIS has been associated with systemic alpha(1)-adrenergic receptor antagonists and other classes of medications for benign prostatic hyperplasia, as well as other systemic disease. The condition is best managed with several surgical and pharmacologic options if anticipated prior to surgery. Such precautions result in excellent surgical and visual acuity outcomes that appear similar to non-IFIS-affected eyes. There is still much to learn about IFIS and its exact causes, as well as a need for agreed upon guidelines that would enable physicians to properly anticipate and successfully manage or even prevent the condition.

Ophthalmic adverse drug reactions to systemic drugs: a systematic review

“…Pubmed search yielded 124 results; SCOPUS yielded 72 results; Google Scholar 60; ISI Web of Knowledge yielded 154; others yielded 152. From these 562 studies (corresponding to 300 distinct studies), 163 were selected to obtain full text and then 32 studies were included (Fig. ): 1 systematic review of ADRs to a specific drug, 11 narrative reviews, 1 trial, 1 prospective study, 6 case–control or cohort or cross‐sectional studies, 6 spontaneous reports and 6 case reports or case series.…”

“…We identified many ophthalmic ADRs to drugs that have original studies but are currently lacking a systematic review (therefore representing an opportunity for further studies, as described in the Discussion Section, below). Many studies were found but only one systematic review (of ophthalmic ADRs to sildenafil) and few narrative reviews with systematic search were performed. Therefore, examples of drugs that cause ophthalmic ADRs that would benefit from a recent and specific systematic review are: tamoxifen, amiodarone, antidepressants, phenotiazines, hydroxychloroquine, oral contraceptives, etc.…”

α‐Adrenergic Antagonists for Lower Urinary Symptoms Secondary to Benign Prostatic Hyperplasia

“…A recent review of the literature reveals the following salient points concerning IFIS and the use of α-blockers [67]. First, the risk of IFIS was substantial among men taking tamsulosin, ranging from about 43% to 90% in 10 retrospective and prospective studies (sometimes the denominator for these risks was patients, and sometimes the number of eyes at risk).…”