Intraoperative floppy iris syndrome associated with tamsulosin

Chang, David F.; Campbell, John R.

doi:10.1016/j.jcrs.2005.02.027

Cited by 472 publications

(488 citation statements)

References 29 publications

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“…The intraoperative floppy iris syndrome (IFIS) is a recently described syndrome 1 in patients who are on systemic tamsulosin (Flomax, Boehringer Ingelheim GmbH, Germany) for the treatment of lower urinary tract symptoms in patients suffering from benign prostatic hypertrophy(BPH).…”

Section: Introductionmentioning

confidence: 99%

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Intracameral phenylephrine to prevent floppy iris syndrome during cataract surgery in patients on tamsulosin

Gurbaxani

Packard

2005

Eye

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Purpose To describe the use of intracameral phenylephrine to prevent the floppy iris syndrome seen in patients who are on the drug tamsulosin for benign prostatic hypertrophy, during cataract surgery. Setting Prince Charles Eye Unit, King Edward VII Hospital, Windsor, Berkshire, UK. Method Seven patients who were on systemic tamsulosin for benign prostatic hypertrophy received intracameral phenylephrine before capsulorexhis during their cataract surgery. Results There was a significant reduction in the amount of mobility of the iris, reduction in the expected fluttering, and sustained papillary dilatation. Conclusion Intracameral phenylephrine is a simple and effective tool to prevent the effects of floppy iris syndrome in those patients undergoing cataract surgery who are on systemic tamsulosin.

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Section: Introductionmentioning

confidence: 99%

“…These pupils do not dilate well either and progressively constrict during the course of the surgery. 1 Conventional methods of preventing complications from floppy iris and poorly dilated pupils include use of iris hooks 2 and spincterotomy 3 among others.…”

Section: Introductionmentioning

confidence: 99%

Intracameral phenylephrine to prevent floppy iris syndrome during cataract surgery in patients on tamsulosin

Gurbaxani

Packard

2005

Eye

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“…The difference may be explained by the fact that the British survey questioned all UK eye surgeons about their experiences; whereas the American study only asked 15 selected and highly experienced surgeons (Chang et al 2007). Pupil stretching and sphincterotomies are usually of no effect because of the elasticity of the pupil margin, and may on the contrary worsen the constriction of the pupil (Chang & Campbell 2005).…”

Section: Use Of Iris Retractorsmentioning

confidence: 99%

Management of Intraocular Floppy Iris Syndrome (IFIS) in Cataract Surgery

Storr‐Paulsen¹

2013

Cataract Surgery

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“…Exactly the same scenario during stromal hydration has been described before. 1 There has also been a report of a cannula flying loose inside the eye during injection of viscoelastic during cataract surgery, resulting in a retinal break. 2 It is probable that there have been other cases which have been unreported.…”

Section: Commentmentioning

confidence: 99%

“…Iatrogenic orbital needle stick injuries have been reported, especially with sliplock systems where needles have become accidentally dislodged during procedures, some with sight threatening consequences. [1][2][3] This case report describes a situation where a slip-lock cannula dislodged under high pressure during the stromal hydration step of what was otherwise a routine cataract procedure. It entered the eye at high velocity and resulted in iris perforation, zonule rupture, hyphaema, and vitreous haemorrhage.…”

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confidence: 99%

Ocular trauma caused by a loose slip-lock cannula during corneal hydration

Bradshaw

Shankar

Maini

et al. 2006

Eye

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the a1A-adrenergic receptors on the iris dilator muscle, resulting in disuse atrophy of the muscle; this in turn affects iris rigidity. 1 Controversy exists over the receptor subtypes present in the prostate and the precise mechanism of action of this type of agents. [2][3][4] Recent experience in our unit is in accord with Chang's report; 1 the majority of patients treated with tamsulosin undergoing cataract surgery seem to display the features of IFIS. We have noted no benefit from the temporary cessation of treatment preoperatively.The case we present here was, we believe, typical of IFIS. We are not aware of any previous reports of IFIS in patients treated with a1-adrenergic receptor blockers other than tamsulosin. It has been suggested that the a1A-subtype selectivity of tamsulosin might be accountable for the clinical manifestation of IFIS. 1 Alfuzosin, although not a1A-subtype-selective in vitro, 2,3,5-9 displays uroselective properties in vivo. [5][6][7] We postulate that the overall in vivo affinity of the a1-adrenergic receptor blockers towards a1A-subtype receptors might be responsible for IFIS rather than the in vitro a1A-selectivity per se. 2,7 We agree with previous authors that preoperative recognition of patients at risk of IFIS allows for appropriate surgical planning in anticipation of IFIS, with the intention of reducing the risk of preoperative complications. 1 It is our practice to insert, at commencement of surgery, disposable flexible translimbal iris retractors in a diamond configuration, as described by Oetting and Omphroy. 10 This seems to allow the operation to be completed safely and with little added difficulty.We believe that surgeons should anticipate IFIS in patients taking alfuzosin, in addition to those taking tamsulosin, and quite possibly in patients taking any of the uroselective a1-adrenergic receptor blockers. We are not aware of any reports of the nonuroselective a1-adrenergic receptor blockers causing IFIS. Comparison of tamsulosin with alfuzosin in the treatment of patients with lower urinary tract symptoms suggestive of bladder outlet obstruction (symptomatic benign prostatic hyperplasia). The European Tamsulosin Study Group. Br J Urol 1997; 80(4): 597-605. 9 Martin DJ, Lluel P, Guillot E, Coste A, Jammes D, Angel I.Comparative alpha-1 adrenoceptor subtype selectivity and functional uroselectivity of alpha-1 adrenoceptor antagonists.

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Intraoperative floppy iris syndrome associated with tamsulosin

Abstract: Intraoperative floppy iris syndrome occurred in approximately 2% of a cataract surgery population and appeared to be caused by tamsulosin, a systemic sympathetic alpha-1A antagonist medication that is the most frequently prescribed medication for benign prostatic hypertrophy.

Cited by 472 publications

References 29 publications

Intracameral phenylephrine to prevent floppy iris syndrome during cataract surgery in patients on tamsulosin

Intracameral phenylephrine to prevent floppy iris syndrome during cataract surgery in patients on tamsulosin

Management of Intraocular Floppy Iris Syndrome (IFIS) in Cataract Surgery

Ocular trauma caused by a loose slip-lock cannula during corneal hydration

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