Prospective masked comparison of intraoperative floppy iris syndrome severity with tamsulosin versus alfuzosin.
نویسندگان
چکیده
OBJECTIVE To determine whether severe intraoperative floppy iris syndrome (IFIS) is more or equally likely with tamsulosin or alfuzosin. DESIGN Prospective, masked, multicenter, cross-sectional study. PARTICIPANTS AND CONTROLS Consecutive patients taking systemic tamsulosin or alfuzosin and scheduled for routine cataract surgery (case group) and patients with no history of systemic α1-antagonists scheduled for routine cataract surgery (control group). METHODS Phacoemulsification with intraocular lens implantation was performed and recorded on video. Intracameral phenylephrine or epinephrine, either by direct injection or placement in the irrigation bottle, was not permitted. Every surgical video subsequently was reviewed remotely by 2 masked investigators who diagnosed the presence or absence of IFIS and graded the severity of IFIS as follows: none, mild (billowing only), moderate (billowing and either iris prolapse or ≥2 mm of pupil constriction), or severe (billowing accompanied by iris prolapse and ≥2 mm of pupil constriction). MAIN OUTCOME MEASURES Rate and severity of IFIS and surgical complication rate. RESULTS A total of 226 eyes (70 in the tamsulosin group, 43 in the alfuzosin group, and 113 in the control group) were enrolled. Severe IFIS was noted in 34.3% (24/70) of the tamsulosin eyes and in 16.3% (7/43) of the alfuzosin eyes compared with 4.4% (5/113) of the control eyes. The differences between each of the 3 groups were statistically significant. In the absence of epinephrine in the irrigation bottle, 12.4% of control eyes had moderate to severe IFIS. There were no instances of posterior capsular rupture or significant surgical complications in either the case or control groups. CONCLUSIONS Moderate to severe IFIS can occur in low-risk eyes when epinephrine is omitted from the irrigation bottle. Although both tamsulosin and alfuzosin significantly increase the risk of IFIS compared with patients without prior α1-antagonist intake, severe IFIS statistically was more likely with tamsulosin than with alfuzosin (P = 0.036). Patients with symptomatic benign prostatic hyperplasia and cataracts requiring a uroselective α1-antagonist may consider trying alfuzosin first.
منابع مشابه
Intraoperative Floppy Iris Syndrome (IFIS) Associated with Systemic Alpha-1 Blockers ASCRS and AAO Educational Update Statement
Since intraoperative floppy iris syndrome (IFIS) was first described in 2005, its association with the systemic alpha-1 adrenergic antagonist, tamsulosin (Flomax®, Boehringer-Ingelheim Pharmaceuticals, Inc., Ridgefield, CT), has become well established [1-7]. The clinical manifestations of IFIS complicating cataract surgery are poor preoperative pupil dilation, iris billowing and prolapse, and ...
متن کاملIntraoperative Floppy Iris Syndrome (IFIS) Associated with Systemic Alpha-1 Blockers ASCRS and AAO Educational Update Statement
Since intraoperative floppy iris syndrome (IFIS) was first described in 2005, its association with the systemic alpha-1 adrenergic antagonist, tamsulosin (Flomax®, Boehringer-Ingelheim Pharmaceuticals, Inc., Ridgefield, CT), has become well established [1-7]. The clinical manifestations of IFIS complicating cataract surgery are poor preoperative pupil dilation, iris billowing and prolapse, and ...
متن کاملIntraoperative Floppy Iris Syndrome (IFIS) Associated with Systemic Alpha-1 Blockers ASCRS and AAO Educational Update Statement
Since intraoperative floppy iris syndrome (IFIS) was first described in 2005, its association with the systemic alpha-1 adrenergic antagonist, tamsulosin (Flomax®, Boehringer-Ingelheim Pharmaceuticals, Inc., Ridgefield, CT), has become well established [1-7]. The clinical manifestations of IFIS complicating cataract surgery are poor preoperative pupil dilation, iris billowing and prolapse, and ...
متن کاملComparative effect of alfuzosin and tamsulosin on the contractile response of isolated rabbit prostatic and iris dilator smooth muscles: possible model for intraoperative floppy-iris syndrome.
PURPOSE To compare the pharmacologic properties of tamsulosin and alfuzosin in isolated prostatic and iris dilator smooth muscle from pigmented rabbits. SETTING UROsphere Laboratories, Université Paul Sabatier, Toulouse, France. METHODS Prostatic and iris dilator smooth muscle strips were placed in organ baths. A concentration-response curve to phenylephrine was compared before and after in...
متن کاملManagement of Intraocular Floppy Iris Syndrome (IFIS) in Cataract Surgery
Intraoperative floppy iris syndrome (IFIS) was first described in 2005 (Chang & Campbell 2005; Parssinen 2005). The fullblown syndrome comprises a triad of: 1) billowing of the iris stroma in response to normal irrigation currents, 2) the floppy iris tends to prolapse through the phaco and the side port incisions, and 3) a progressive pupillary constriction during the surgical procedure. Althou...
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ورودعنوان ژورنال:
- Ophthalmology
دوره 121 4 شماره
صفحات -
تاریخ انتشار 2014