Antipsychotic agent as an etiologic agent of IFIS.

In their paper on the intraoperative floppy iris syndrome (IFIS), Chang and Campbell raise awareness of an important clinical syndrome we have encountered on 2 separate occasions that proved challenging to complete safely; in hindsight, it was IFIS. In 1 case, we used Healon GV (Pfizer), which seemed to limit iris prolapse into the wound. We are interested to knowwhy the authors chose 1 to 2 weeks as a ‘‘wash-out’’ period before cataract surgery, as the authors state that even after long-term cessation, mild iris floppiness was seen. Because the urological symptoms (International Prostate Symptom Score) and the urodynamics are taken into account before tamsulosin is started, we think the patient would benefit from liaison with the urologist or their general practitioner (GP) before stopping treatment or considering options for alternative nonselective a-1 receptor antagonists such as prazosin, terazosin, or doxazosin. It may also be useful if IFIS could be recognized and published as a potential side effect of tamsulosin so urologists and GPs would have the option to suggest alternative treatment as a first choice in older patients whomay be expected to have cataract surgery. It is perhaps too early to know whether alfuzosin (Uroxatral), a new nonsubtype-selective a-1 blocker launched in November 2003, is a safer alternative than tamsulosinassociated IFIS. We congratulate the authors on bringing this new syndrome to light. The report will aid cataract surgeons in anticipating potential complications in patients with tamsulosin-associated IFIS. The potential operating difficulties should be considered before trainee surgeons perform cataract surgery in such patients.