The role of sex in intraoperative floppy-iris syndrome

Tzamalis, Argyrios; Matsou, Artemis; Dermenoudi, Maria; Brazitikos, Periklis; Tsinopoulos, Ioannis

doi:10.1016/j.jcrs.2018.08.029

Cited by 24 publications

(34 citation statements)

References 19 publications

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“…The appearance of intraoperative floppy iris syndrome has been shown to be affected by many reasons and various systemic medications. [5][6][7][8][9][10] However, IFIS came in the spotlight when the therapeutic algorithm for the treatment of benign prostatic hyperplasia (BPH) suggested the intake of a1-ARA as the first line treatment, substituting surgical intervention. 13 Three subtypes of a1-adrenergic receptors (a1-AR) have been identified so far: a1 A , a1 B and a1 D .…”

Section: Pathogenetic Mechanismmentioning

confidence: 99%

“…Regarding gender, a strong positive correlation has been found between IFIS and male sex. 5,7,9,40 The significantly higher prevalence of IFIS among men, can obviously be attributed to the intake of a1-ARAs for BHP treatment. IFIS however, occurs in females too, although less commonly than in males, thus women are unfortunately often overlooked as high-risk candidates for IFIS development.…”

Section: Gender and Agementioning

confidence: 99%

“…IFIS however, occurs in females too, although less commonly than in males, thus women are unfortunately often overlooked as high-risk candidates for IFIS development. 9 Notably, IFIS in women has been correlated with a higher incidence of intraoperative complications than in men, including posterior capsule rupture, vitreous loss, nucleus drop and endothelial cell loss, leading in a significantly worse final visual outcome. 9 Clinicians should not forget that females, although less frequently than men, are also prescribed a1-ARAs for outlet obstruction and detrusor underactivity, as well as other drugs that are related to IFIS such as benzodiazepines, angiotensin receptor inhibitors and antipsychotics.…”

Section: Gender and Agementioning

confidence: 99%

“…9 Notably, IFIS in women has been correlated with a higher incidence of intraoperative complications than in men, including posterior capsule rupture, vitreous loss, nucleus drop and endothelial cell loss, leading in a significantly worse final visual outcome. 9 Clinicians should not forget that females, although less frequently than men, are also prescribed a1-ARAs for outlet obstruction and detrusor underactivity, as well as other drugs that are related to IFIS such as benzodiazepines, angiotensin receptor inhibitors and antipsychotics. All these predisposing factors should be clearly documented during preoperative visits in order to avoid unanticipated IFIS that could have a detrimental effect to the surgical outcome.…”

Section: Gender and Agementioning

confidence: 99%

“…Beyond the original correlation with tamsulosin intake, 1 IFIS has been correlated with several risk factors which include: gender, age, hypertension, other a1-adrenergic receptor antagonists (a1-ARAs), finasteride, angiotensin II receptor inhibitors, benzodiazepines, antipsychotics, hypertension drugs and decreased dilated pupil diameter. [5][6][7][8][9][10] The careful preoperative assessment of these predisposing factors is essential in the stratification of the preoperative risk. As a matter of fact, IFIS is associated with higher rate of complications, that include increased ocular inflammation, posterior capsule rupture, anterior capsule tears, vitreous loss, iris trauma, cystoid macular edema and hyphema.…”

Section: Introductionmentioning

confidence: 99%

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<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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Section: Pathogenetic Mechanismmentioning

confidence: 99%

Section: Gender and Agementioning

confidence: 99%

Section: Gender and Agementioning

confidence: 99%

Section: Gender and Agementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Christou¹,

Tsinopoulos²,

Ziakas³

et al. 2020

OPTH

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Survey of Ehlers‒Danlos Patients’ ophthalmic surgery experiences

Louie

Meyerle

Francomano

et al. 2020

Molec Gen & Gen Med

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Background: Ehlers-Danlos Syndrome (EDS) is a rare disease affecting approximately 1 in 5,000 people. Although ophthalmic conditions associated with EDS have been described, little data exist concerning ophthalmic surgical outcomes experienced by EDS patients. Methods: Patients with EDS were surveyed via the EDS Society and asked about their ophthalmic surgical experiences including procedure, complications, and the timing with respect to receiving the EDS diagnosis. Complications were confirmed as such by subspecialists. Results: Of 579 respondents, 467 reported confirmed EDS, and 112 of those had an ophthalmic procedure, including refractive surgery, cataract/lens surgery, retinal surgery, strabismus surgery, oculoplastic surgery, corneal surgery, and laser surgery for glaucoma. The rate of confirmed complications was: 23%-refractive, 33%-lens/ cataract, 33%-retina, 59%-strabismus, 23%-oculoplastics, 0%-cornea, and 25%-glaucoma laser. In addition, 76% of patients underwent surgery prior to the EDS diagnosis. Conclusions: Patients with EDS may have elevated risk of postoperative ophthalmic surgical complications. It would seem reasonable to systemically and prospectively explore how patients with EDS respond to ophthalmic surgery. Furthermore, it would seem circumspect to ask surgical candidates patients about whether they carry a diagnosis of EDS or have signs and symptoms of EDS prior to surgery.

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Floppy Iris Syndrome

Tzamalis

Malyugin

2022

Cataract Surgery

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The role of sex in intraoperative floppy-iris syndrome

Cited by 24 publications

References 19 publications

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

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

Survey of Ehlers‒Danlos Patients’ ophthalmic surgery experiences

Floppy Iris Syndrome

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