Effect of phenylephrine 1.0%–ketorolac 0.3% injection on tamsulosin-associated intraoperative floppy-iris syndrome

Silverstein, Steven; Rana, Viren K.; Stephens, Robert E.; Segars, Larry; Pankratz, Joseph; Rana, Shivani; Juzych, Mark S; Nariman, Nissiri

doi:10.1016/j.jcrs.2018.05.029

Cited by 15 publications

(14 citation statements)

References 8 publications

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“…The analysis failed to show positive results in a reduction of severe forms, reconsidering ARA α1A withdrawal and a rational interruption of causative pharmacological treatment in some patients. [ 50 ]…”

Section: Resultsmentioning

confidence: 99%

Intraoperative Floppy Iris Syndrome Induced by Tamsulosin

Tobaiqy

Aalam

Banji

et al. 2021

Middle East African Journal of Ophthalmology

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Tamsulosin is an antagonist of a subtype-specific alpha-1A- and alpha-1D-adrenoceptor (AR) that is expressed in the prostate gland, urethra, and bladder. Several reports have shown a possible relationship between ophthalmologic adverse effects and the use of alpha-1-receptor medicines, including tamsulosin. This descriptive review evaluates the intraoperative floppy iris syndrome (IFIS) associated with tamsulosin. A search of the Medline and PubMed databases was conducted to identify control trials, case reports, and observational examinations published in English. The publication dates were restricted (January 1, 2000, to January 1, 2020). Keywords (tamsulosin, alpha-blocker, ocular, eye, adverse reaction, and IFIS) were used in the searches. The searches identified 66 studies including in vitro or in vivo studies, trials, and observational studies. Twenty-two (33.33%) studies were articles citing tamsulosin and IFIS as having confirmed potential risk to ocular safety. The results of this review, including a comprehensive summary of published research on tamsulosin use in different populations, have identified several articles showing associations between tamsulosin and IFIS that merit further investigation. Suspending of potential causative pharmacological treatment of IFIS before ocular surgery including tamsulosin, proper identification of at-risk patients, preoperative prophylaxis treatments, and surgical technique modifications clearly can mitigate the anticipated risk of IFIS induced by tamsulosin.

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Section: Resultsmentioning

confidence: 99%

Intraoperative Floppy Iris Syndrome Induced by Tamsulosin

Tobaiqy

Aalam

Banji

et al. 2021

Middle East African Journal of Ophthalmology

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“…61 FDA recently approved a combination of phenylephrine 1% and ketorolac 0.3% for intraocular use during cataract surgery to prevent intraoperative miosis and iris flaccidity and to decrease postoperative pain. 52,62,63 Specifically, Donnenfeld et al designed a randomized clinical trial where patients were randomized administrated with either vehicle or phenylephrine or ketorolac or the study drug containing phenylephrine and ketorolac intracamerally during surgery. Regarding the maintenance of mydriasis, the percentages of patients with an intraoperative pupil diameter <6mm were 47.2% for the vehicle, 22.4% for the phenylephrine, 34.6% for the ketorolac and 6.1% for the study drug.…”

Section: Intraoperative Managementmentioning

confidence: 99%

“…63 These results of the fixed combination are promising so far, as it is shown to reduce the incidence of IFIS in patients receiving tamsulosin and maintain intraoperative mydriasis, either injected intracamerally or being added to the irrigation solution during cataract surgery. 62,63 Although pupil constriction minimizing surgical visibility is the main concern of cataract surgeons in IFIS patients, iris prolapse can also be a major intraoperative issue leading to complications such as wound dehiscence, iatrogenic iris injury, postoperative endophthalmitis etc. 11,12 In order to deal with iris prolapse, several tricks have been described such as lowering intraocular pressure followed by "milking" the iris back into the anterior chamber.…”

Section: Intraoperative Managementmentioning

confidence: 99%

<p>Intraoperative Floppy Iris Syndrome: Updated Perspectives</p>

Christou¹,

Tsinopoulos²,

Ziakas³

et al. 2020

OPTH

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Almost fifteen years since its initial description, intraoperative floppy iris syndrome (IFIS) during phacoemulsification surgery remains a challenge for cataract surgeons in all its key aspects that include the stratification of the preoperative risk, preoperative prophylaxis treatment, surgery design and intraoperative management. Since its original association with tamsulosin intake, IFIS has been positively correlated with a plethora of risk factors which include: gender, age, hypertension, other a1-adrenergic receptor antagonists, finasteride, angiotensin II receptor inhibitors, benzodiazepines, antipsychotics, hypertension drugs and decreased dilated pupil diameter. The assessment and stratification of the preoperative risk is pivotal in screening patients prone to develop IFIS. For these patients, it is essential that preoperative prophylaxis, employment of necessary measures and surgical technique modifications are considered. A multidisciplinary approach of IFIS is a mandate, thus ophthalmologists, urologists and sometimes other specialties should cooperate to "educate" each other about the risks of their respective fields. They both must be aware of the joint statement on IFIS by the American Academy of Ophthalmology and the American Society of Cataract and Refractive Surgery which suggests either the initiation of tamsulosin after phacoemulsification or the use of a non-selective a1-ARA for benign prostatic hyperplasia treatment. In conclusion, awareness of the risk factors associated with IFIS and their detailed preoperative documentation is crucial in addressing IFIS. The lack of such an awareness can turn a routine, uneventful surgery into one with significant visual morbidity.

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“…The mixture of 1.0% phenylephrine and 0.3% ketorolac adding irrigation solution during surgery can prevent or reduce the severity of IFIS. However, this solution is created based on experience with Caucasian population, which may not be readily usable in other races (45). Intracameral phenylephrine can reduce iris floppiness and promote iris dilation, which can be recommended in most cases with progressive miosis.…”

Section: Intraoperative Measuresmentioning

confidence: 99%

A narrative review of intraoperative floppy iris syndrome: an update 2020

Yang¹,

Liu²,

Zhi-gang³

et al. 2020

Ann Transl Med

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Intraoperative floppy iris syndrome (IFIS) is characterized by intraoperative floppiness or billowing of the iris, progressive miosis, and iris prolapse through the surgical wounds. It was originally reported about fifteen years ago, which was later identified to be closely associated with tamsulosin, the most commonly used α1 adrenoceptor antagonist for benign prostatic hyperplasia (BPH). A variety of risk factors, including age, gender, hypertension, axial length of the eye, 5α-reductase inhibitors, other α adrenoceptor antagonist and neuromodulators, have been connected with IFIS. If IFIS occurs during phacoemulsification surgery, complications such as corneal endothelial loss, iris trauma, posterior capsule rupture (PCR), high intraocular pressure and vitreous loss are significantly increased. Therefore, preoperative evaluation of high-risk patients and appropriate intraoperative intervention is crucial to avoid severe complications. This review summarizes the pathogenesis and clinical features of classic IFIS, and provides some clinical pearls to ophthalmologists that may help identify, prevent or reduce IFIS associated complications. Additionally, from the perspective of clinical occurrence of IFIS, there are some recommendations for urologists as well.In conclusion, both ophthalmologists and urologists should be aware of this special clinical situation and communicate with each other about their own fields. A multidisciplinary interaction is of importance to simplify potentially complicated clinical issues.

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Effect of phenylephrine 1.0%–ketorolac 0.3% injection on tamsulosin-associated intraoperative floppy-iris syndrome

Cited by 15 publications

References 8 publications

Intraoperative Floppy Iris Syndrome Induced by Tamsulosin

Intraoperative Floppy Iris Syndrome Induced by Tamsulosin

<p>Intraoperative Floppy Iris Syndrome: Updated Perspectives</p>

A narrative review of intraoperative floppy iris syndrome: an update 2020

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