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Park SSE, Wilkinson S, Mamalis N. Dealing with floppy iris syndrome. Curr Opin Ophthalmol 2022; 33:3-8. [PMID: 34711714 DOI: 10.1097/icu.0000000000000815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The aim of this study was to review and summarize recent findings and advancements regarding intraoperative floppy iris syndrome (IFIS). Although many improvements have been made for the management of IFIS, it remains a challenging condition for surgeons. An understanding of the syndrome as well as the multitude of tools to mitigate risk of complication is important for surgeons operating on high-risk patients. RECENT FINDINGS A variety of management approaches have been modified and improved or further supported with new data, such as intracameral compounds, intraoperative devices and surgical techniques. SUMMARY An understanding of risk factors is important for the identification of at-risk patients. A variety of approaches can greatly reduce incidence of IFIS complications. Multiple management strategies should be utilized to further reduce risk during these difficult surgeries.
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Affiliation(s)
- Sally S E Park
- John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
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Vural GS, Vural M. Predictive value of pupillography on intraoperative floppy iris syndrome in preoperative period. Int J Ophthalmol 2021; 14:1018-1024. [PMID: 34282386 DOI: 10.18240/ijo.2021.07.09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 02/25/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To present the frequency of intraoperative floppy iris syndrome (IFIS) in cataract patients who taking alpha 1-a receptor antagonist (ARA) drugs, and evaluate the predictive value of pupil diameter (PD) changes in IFIS patients. METHODS Male cataract patients who are under treatment with alpha-1a-ARAs (alfuzosin, tamsulosin) intraoperatively were evaluated and were grouped as with/without IFIS. The preoperative PD values were compared with controls. Also, the intraoperative manipulations and early/late complications were recorded. RESULTS A total of 77 patients (77 eyes) of 94 benign prostate hyperplasia (BPH) patients have been defined as IFIS (81.91%) and 40 patients (40 eyes) were taking tamsulosin and 37 patients (37 eyes) were taking alfuzosin. During the cataract surgery, the rate of posterior capsular rupture (P=0.754), vitreous loss (P=0.585), iris tears (P=0.004), and iris catching (P=0.000) were higher in IFIS group, but the difference was significant only in the iris catching. At the postoperative first-month visit, persistent IOP rise and iris stromal tears were more frequent in IFIS group, but the difference was not significant (P=0.311, P=0.146; respectively). In contrast, Descemet membrane detachment was insignificantly more frequent in controls (P=0.311). In IFIS and control patients, PDs were 9.54±1.78 and 9.72±1.57 mm (P=0.255) under scotopic illumination, 8.54±1.43 and 8.74±1.25 mm (P=0.289) under mesopic illumination, 6.99±1.35 and 7.27±1.39 mm (P=0.662) under photopic illumination, respectively. However PDs were lower in IFIS under all illumination degrees, no significant difference was detected between groups. CONCLUSION IFIS is a significant clinical syndrome with an increased intraoperative/postoperative complication ratio. The prediction of this syndrome is important because of prevention required precautions against possible complications. There is no association between IFIS and preoperative PD.
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Affiliation(s)
- Gozde Sahin Vural
- Department of Ophthalmology, Balikesir University Medicine Faculty, Balikesir 10100, Turkey
| | - Mehmet Vural
- Department of Ophthalmology, Balikesir Ataturk State Hospital, Balikesir 10020, Turkey
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Syed MF, Rehmani A, Yang M. Ocular Side Effects of Common Systemic Medications and Systemic Side Effects of Ocular Medications. Med Clin North Am 2021; 105:425-444. [PMID: 33926639 DOI: 10.1016/j.mcna.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
When prescribing medications, it is important to consider the ocular side effects of common systemic therapy as well as potential systemic side effects of ocular medications. Although not an exhaustive list of medications/classes of medications, this article does include many commonly used drugs and also provides information on some topical therapies commonly used by ophthalmologists. These ocular medications may result in systemic effects and/or alter patients' management of systemic conditions.
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Affiliation(s)
- Misha F Syed
- University of Texas Medical Branch, 700 University Boulevard, Galveston, TX 77555, USA.
| | - Ahmad Rehmani
- University of Texas Medical Branch, 700 University Boulevard, Galveston, TX 77555, USA
| | - Matthew Yang
- University of Texas Medical Branch, 700 University Boulevard, Galveston, TX 77555, USA
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Tobaiqy M, Aalam W, Banji D, Al Haleem ENA. Intraoperative Floppy Iris Syndrome Induced by Tamsulosin: The Risk and Preventive Strategies. Middle East Afr J Ophthalmol 2021; 28:51-56. [PMID: 34321822 PMCID: PMC8270016 DOI: 10.4103/meajo.meajo_561_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/17/2021] [Accepted: 03/17/2021] [Indexed: 11/04/2022] Open
Abstract
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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Affiliation(s)
- Mansour Tobaiqy
- Department of Pharmacology, College of Medicine, University of Jeddah, Jeddah, Kingdom of Saudi Arabia
| | - Waseem Aalam
- Department of Ophthalmology, College of Medicine, University of Jeddah, Jeddah, Kingdom of Saudi Arabia
| | - David Banji
- Department of Pharmacy Practice, Pharmacy Practice Research Unit, College of Pharmacy, Jazan University, Jazan, Saudi Arabia
| | - Ekram N Abd Al Haleem
- Department of Pharmacology and Toxicology, College of Pharmacy (Girls), Al-Azhar University, Cairo, Egypt
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Affiliation(s)
- Pammal T Ashwin
- Birmingham and Midland Eye Centre, Birmingham, United Kingdom
| | - Sunil Shah
- Birmingham and Midland Eye Centre, Birmingham, United Kingdom
- Aston University, School of Life and Health Sciences, Ophthalmic Research Group, Birmingham, United Kingdom E‐mail:
| | - James S Wolffsohn
- Aston University, School of Life and Health Sciences, Ophthalmic Research Group, Birmingham, United Kingdom E‐mail:
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Arbeitsgruppe Inkontinenz der DGG (Autoren in alphabetischer Ordnung): Klaus Becher, Barbara Bojack, Sigrid Ege, Silke von der Heide, Ruth Kirschner-Hermanns, Andreas Wiedemann. Federführende Gesellschaft: Deutsche Gesellschaft für Geriatrie. [Urinary incontinence in geriatric patients: diagnosis and therapy]. Aktuelle Urol 2019; 50:s11-s59. [PMID: 30818399 DOI: 10.1055/a-0852-4842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Blau-Most M, Mimouni M, Geffen N, Segal O, Segev F. Modified Corneal Incisions for Cataract Surgery in Patients Treated with Tamsulosin: A Prospective Study. Curr Eye Res 2018; 44:381-384. [PMID: 30526129 DOI: 10.1080/02713683.2018.1557211] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To evaluate modified anterior elongated corneal incisions as a simple technique to reduce the incidence and severity of intraoperative floppy iris syndrome (IFIS), in patients taking tamsulosin (a selective α1a-adrenergic receptor antagonist). METHODS This prospective case series was conducted at Meir Medical Center, a tertiary care facility in Israel. Included were 45 eyes of 39 male patients taking tamsulosin, and thus prone to IFIS. Patients underwent phacoemulsification cataract surgery with anterior elongated corneal incisions. The primary outcomes were the incidence and severity of IFIS, the complication rate and the need for additional IFIS management techniques. The secondary outcome was to quantify the surgically induced astigmatism, using Alpin's vector analysis. The tamsulosin treatment period and pupil diameter during five stages of the surgery were also noted. RESULTS The overall rate of IFIS was 33.33% (n = 15). The IFIS severity was rated as mild in 22.22% and moderate in 11.11% of the study eyes. No IFIS was noted in 66.67% of the eyes. There were no cases of severe IFIS, and no need for other IFIS management strategies. The complications rate was 2.22% (n = 1). Patients who developed IFIS had a significantly smaller pupil at the beginning of surgery (p < 0.05). There was no significant difference in tamsulosin treatment period between patients with and without IFIS (p = 0.19). The centroid - the mean SIA vector was 0.51 D @ 18° ±1.5 D (SD). CONCLUSIONS In tamsulosin treated patients, using modified corneal incisions may be feasible in order to reduce the incidence and severity of IFIS during cataract surgery. Future randomized studies are warranted.
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Affiliation(s)
- Michal Blau-Most
- a Department of Ophthalmology , Meir Medical Center , Kfar Sava , Israel.,b Sackler School of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Michael Mimouni
- c Department of Ophthalmology , Rambam Health Care Campus affiliated to the Technion Israel Institute of Technology , Haifa , Israel
| | - Noa Geffen
- b Sackler School of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Ori Segal
- a Department of Ophthalmology , Meir Medical Center , Kfar Sava , Israel.,b Sackler School of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Fani Segev
- a Department of Ophthalmology , Meir Medical Center , Kfar Sava , Israel.,b Sackler School of Medicine , Tel Aviv University , Tel Aviv , Israel
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Bonnell LN, SooHoo JR, Seibold LK, Lynch AM, Wagner BD, Davidson RS, Taravella MJ. One-day postoperative intraocular pressure spikes after phacoemulsification cataract surgery in patients taking tamsulosin. J Cataract Refract Surg 2018; 42:1753-1758. [PMID: 28007106 DOI: 10.1016/j.jcrs.2016.10.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 09/22/2016] [Accepted: 10/05/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the relationship between 1-day postoperative intraocular pressure (IOP) after phacoemulsification cataract surgery and tamsulosin use. SETTING University of Colorado Health Eye Center, Aurora, Colorado, USA. DESIGN Retrospective cohort study. METHODS Registry data from men who had cataract surgery were used. Patients taking tamsulosin at the time of surgery were included as cases, while patients with no history of tamsulosin use were used as controls. The primary outcome was a 1-day postoperative IOP spike defined as an IOP increase greater than 10 mm Hg compared with baseline or a 1-day postoperative IOP of 30 mm Hg or higher. General estimating equations were used for analysis. RESULTS The study comprised 584 men (864 eyes). An IOP increase greater than 10 mm Hg or IOP 30 mm Hg or higher after cataract surgery occurred in 12.4% and 9.3%, respectively, of eyes in the tamsulosin group versus 4.4% and 2.1%, respectively, in the control group (all P = .001). After adjusting for significant covariates, patients on tamsulosin were 2.6 times (95% confidence interval [CI], 1.2-5.7; P = .01] and 3.8 (95% CI, 1.3-10.9; P = .01) more likely to have a 1-day postoperative IOP increase greater than 10 mm Hg or a 1-day postoperative IOP of 30 mm Hg or higher. CONCLUSION Patients on tamsulosin had an increased risk of a 1-day postoperative IOP spike after cataract surgery, showing the importance of identifying patients on tamsulosin preoperatively to better manage and potentially mitigate IOP spikes. FINANCIAL DISCLOSURE None of the authors has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Levi N Bonnell
- From the Department of Ophthalmology (Bonnell, SooHoo, Seibold, Lynch, Davidson, Taravella), University of Colorado School of Medicine, and the Department of Biostatistics & Informatics (Wagner), Colorado School of Public Health, Aurora, Colorado, USA.
| | - Jeffrey R SooHoo
- From the Department of Ophthalmology (Bonnell, SooHoo, Seibold, Lynch, Davidson, Taravella), University of Colorado School of Medicine, and the Department of Biostatistics & Informatics (Wagner), Colorado School of Public Health, Aurora, Colorado, USA
| | - Leonard K Seibold
- From the Department of Ophthalmology (Bonnell, SooHoo, Seibold, Lynch, Davidson, Taravella), University of Colorado School of Medicine, and the Department of Biostatistics & Informatics (Wagner), Colorado School of Public Health, Aurora, Colorado, USA
| | - Anne M Lynch
- From the Department of Ophthalmology (Bonnell, SooHoo, Seibold, Lynch, Davidson, Taravella), University of Colorado School of Medicine, and the Department of Biostatistics & Informatics (Wagner), Colorado School of Public Health, Aurora, Colorado, USA
| | - Brandie D Wagner
- From the Department of Ophthalmology (Bonnell, SooHoo, Seibold, Lynch, Davidson, Taravella), University of Colorado School of Medicine, and the Department of Biostatistics & Informatics (Wagner), Colorado School of Public Health, Aurora, Colorado, USA
| | - Richard S Davidson
- From the Department of Ophthalmology (Bonnell, SooHoo, Seibold, Lynch, Davidson, Taravella), University of Colorado School of Medicine, and the Department of Biostatistics & Informatics (Wagner), Colorado School of Public Health, Aurora, Colorado, USA
| | - Michael J Taravella
- From the Department of Ophthalmology (Bonnell, SooHoo, Seibold, Lynch, Davidson, Taravella), University of Colorado School of Medicine, and the Department of Biostatistics & Informatics (Wagner), Colorado School of Public Health, Aurora, Colorado, USA
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Abstract
Purpose (1) To use finite element (FE) modelling to estimate local iris stresses (i.e. internal forces) as a result of mechanical pupil expansion; and to (2) compare such stresses as generated from several commercially available expanders (Iris hooks, APX dilator and Malyugin ring) to determine which design and deployment method are most likely to cause iris damage. Methods We used a biofidelic 3-part iris FE model that consisted of the stroma, sphincter and dilator muscles. Our FE model simulated expansion of the pupil from 3 mm to a maximum of 6 mm using the aforementioned pupil expanders, with uniform circular expansion used for baseline comparison. FE-derived stresses, resultant forces and area of final pupil opening were compared across devices for analysis. Results Our FE models demonstrated that the APX dilator generated the highest stresses on the sphincter muscles, (max: 6.446 MPa; average: 5.112 MPa), followed by the iris hooks (max: 5.680 MPa; average: 5.219 MPa), and the Malyugin ring (max: 2.144 MPa; average: 1.575 MPa). Uniform expansion generated the lowest stresses (max: 0.435MPa; average: 0.377 MPa). For pupil expansion, the APX dilator required the highest force (41.22 mN), followed by iris hooks (40.82 mN) and the Malyugin ring (18.56 mN). Conclusion Our study predicted that current pupil expanders exert significantly higher amount of stresses and forces than required during pupil expansion. Our work may serve as a guide for the development and design of next-generation pupil expanders.
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Becher KF. [Pharmacotherapy of urinary incontinence in the elderly]. Internist (Berl) 2016; 57:390-8. [PMID: 26886709 DOI: 10.1007/s00108-016-0026-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The prevalence and the incidence of Urinary Incontinence is growing. Women suffer predominantly from stress and mixed urinary incontinence and men from urge incontinence. In elderly people, the pathophysiological and the physiological change in the lower urinary tract system must be considered as well as an underlying multimorbidity. Stress urinary incontinence is among others caused by an insufficient urethral closure mechanism and urge incontinence is followed by unhibited detrusor contractions. Medical treatment is beside other important conservative options only one part of the treatment strategy in incontinence. Duloxetine, a serotonine-norepinephrine reuptake inhibitore can increase activity of the external urethral sphincter and is able to reduce incontinence episodes in up to 64 %. Antagonists of muscarinic receptors can reduce urgency, frequency and urge incontinence as well as increase bladder capacity significantly. In Germany, darifenacin, fesoterodin, oxybutynin, propiverine, solifenacin, tolterodine and trospium chloride are available to treat urge incontinence. The efficacy of these agents are almost comparable in the elderly with the exception of oxybutynin IR. However, tolerability is different and not well studied in the elderly population with the exception of fesoterodin. Side effects, especially dry mouth, dizziness and constipation often limit their use. None of the agents show ideal efficacy or tolerability in all patients. Last summer therefore a β3-agonist mirabegron was also introduced in Germany but was withdrawn.
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Affiliation(s)
- K F Becher
- Abteilung Geriatrie und Frührehabilitation, HELIOS Hanseklinikum Stralsund, Große Parower Str. 47-53, 18435, Stralsund, Deutschland.
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Pupil Dilation with Intracameral Epinephrine Hydrochloride during Phacoemulsification and Intraocular Lens Implantation. J Ophthalmol 2016; 2016:4917659. [PMID: 26904274 PMCID: PMC4745390 DOI: 10.1155/2016/4917659] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 01/05/2016] [Indexed: 12/13/2022] Open
Abstract
Objective. To investigate mydriatic effect of intracamerally injected epinephrine hydrochloride during phacoemulsification and intraocular lens (IOL) implantation. Methods. Eighteen cataract patients for bilateral phacoemulsification were enrolled. To dilate pupil, one eye was randomly selected to receive intracamerally 1 mL epinephrine hydrochloride 0.001% for 1 minute after corneal incision (intracameral group), and the contralateral eye received 3 drops of compound tropicamide 0.5% and phenylephrine 0.5% at 5-minute intervals 30 minutes before surgery (topical group). Pupil diameters were measured before corneal incision, before ophthalmic viscoelastic device (OVD) injection, after OVD injection, before IOL implantation, and at the end of surgery. Results. At each time point, the mean pupil diameter in the intracameral group was 2.20 ± 0.08, 5.09 ± 0.20, 6.76 ± 0.19, 6.48 ± 0.18, and 5.97 ± 0.24 mm, respectively, and in the topical group it was 7.98 ± 0.15, 7.98 ± 0.15, 8.53 ± 0.14, 8.27 ± 0.16, and 7.93 ± 0.20 mm, respectively. The topical group consistently had larger mydriatic effects than the intracameral group (P < 0.05). The onset of mydriatic effect was rapid in the intracameral group. There was no difference in surgical performance or other parameters between groups. Conclusions. Intracameral epinephrine hydrochloride appears to be an alternative to the mydriatic modalities for phacoemulsification and IOL implantation. In comparison with topical mydriatics, intracameral epinephrine hydrochloride offers easier preoperative preparation, more rapid pupil dilation, and comparable surgical performance.
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Hillelsohn JH, Liu GT, Hymowitz MB, Shrivastava A, Schultz JS. The differential pupillary response to 2.5% phenylephrine in patients taking tamsulosin. J Ocul Pharmacol Ther 2015; 31:169-73. [PMID: 25658979 DOI: 10.1089/jop.2014.0058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To determine if a pharmacological test could be developed to determine iris dilator dysfunction in patients taking tamsulosin. METHODS Patients taking tamsulosin and controls were recruited from the Urology and Ophthalmology clinics at the Montefiore Medical Center. The patient's right eye (OD) was dilated with phenylephrine hydrochloride 2.5% and tropicamide 1%. The patient's left eye (OS) was dilated with tropicamide 1% alone. Forty minutes after dilation, pupillary diameter was measured in both eyes. RESULTS Thirty-eight tamsulosin subjects and 43 controls met the inclusion criteria for the study. The tamsulosin-treated patients dilated less with phenylephrine than controls (0.61±0.4 vs. 1.10±0.45 mm, respectively P<0.001). Receiver operating characteristic curves comparing maximal pupillary dilation versus differential pupillary dilation in tamsulosin patients relative to controls shows a greater area under the curve for differential dilation (0.8 vs. 0.6, respectively). A correlation between smooth muscle dysfunction and length of time on tamsulosin was observed. Patients using tamsulosin for <1 month had an average OD-OS difference of 0.85±0.5 mm. Patients who were on tamsulosin for >1 month had an average OD-OS difference of 0.52±0.32 mm (P<0.01, Mann-Whitney). CONCLUSION Patients treated with tamsulosin demonstrated a significantly decreased iris dilatory response to the selective adrenergic effects of phenylephrine compared to controls. Additionally, it appears that longer duration of exposure to tamsulosin increases the likelihood of dilator dysfunction.
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Affiliation(s)
- Joel H Hillelsohn
- Montefiore Medical Center, The Henkind Eye Institute , Bronx, New York
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Aktas Z, Yuksel N, Ceylan G, Polat F, Hasanreisoglu M, Hasanreisoglu B. The effects of tamsulosin and alfuzosin on iris morphology: an ultrasound biomicroscopic comparison. Cutan Ocul Toxicol 2014; 34:38-41. [PMID: 24730669 DOI: 10.3109/15569527.2014.903262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT It is well known that Alpha-1 adrenergic receptor antagonists affect the receptors in the prostate and also iris dilator muscle, leading to loss of iris muscle tone. OBJECTIVE To compare morphological alterations of iris secondary to tamsulosin and alfuzosin use. PARTICIPANTS Patients included in the study were grouped as follows: 16 patients treated with tamsulosin (Group 1), 14 patients treated with alfuzosin (Group 2) and 18 untreated controls (Group 3). MATERIALS AND METHODS All patients underwent ultrasound biomicroscopic and pupillometric examination. Iris thickness was measured at the dilator muscle region (DMR; measured at half of the distance between the scleral spur and the pupillary margin) and sphincter muscle region (SMR; Standardized at 0.75 mm from the pupillary margin). DMR/SMR was also calculated for each patient. Differences among groups were analysed. Main outcome measures were DMR, SMR, DMR/SMR and pupillary diameter. RESULTS Mean duration of treatments were 2.4 ± 0.96 years (1-4) and 2.3 ± 1.01 years (1-4) in Groups 1 and 2. Pupillary diameters were reduced in Groups 1-2 compared to Group 3 (p < 0.001, p < 0.001). The SMR was similar in Groups 1 and 2 (p: 0.114). These values were not significantly different from that of Group 3 (p: 0.196, p: 0.209). However, thickness in the DMR in Groups 1-2 were significantly lower than that of controls (Group 3) whereas there was no significant difference between Groups 1 and 2 (p: 0.041, p: 0.039 and 0.986, respectively). Mean DMR/SMR ratios were significantly lower in Groups 1-2 than that of Group 3 (p: 0.040 and p: 0.040, respectively). CONCLUSIONS In patients using these medications, the iris seems to be thinner at the dilator muscle region, but preserving the sphincter muscle region.
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Affiliation(s)
- Zeynep Aktas
- Department of Ophthalmlogy, Gazi University Medical Faculty , Ankara , Turkey
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Miguel A, Henriques F, Azevedo LF, Pereira AC. Ophthalmic adverse drug reactions to systemic drugs: a systematic review. Pharmacoepidemiol Drug Saf 2014; 23:221-33. [DOI: 10.1002/pds.3566] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 11/10/2013] [Accepted: 12/09/2013] [Indexed: 11/07/2022]
Affiliation(s)
- Ana Miguel
- Center for Research in Health Technologies and Information Systems (CINTESIS) and Department of Health Information and Decision Sciences, Faculty of Medicine; University of Porto; Portugal
- Department of Ophthalmology; Central University Hospital of Coimbra; Coimbra Portugal
| | - Filipe Henriques
- Department of Ophthalmology; Central University Hospital of Coimbra; Coimbra Portugal
| | - Luís Filipe Azevedo
- Center for Research in Health Technologies and Information Systems (CINTESIS) and Department of Health Information and Decision Sciences, Faculty of Medicine; University of Porto; Portugal
| | - Altamiro Costa Pereira
- Center for Research in Health Technologies and Information Systems (CINTESIS) and Department of Health Information and Decision Sciences, Faculty of Medicine; University of Porto; Portugal
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Park HG, Choi S. Incidence and Risk Factors of Intraoperative Floppy Iris Syndrome During Cataract Surgery. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2014. [DOI: 10.3341/jkos.2014.55.1.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ho Gyun Park
- Department of Ophthalmology, Veterans Health Service Medical Center, Seoul, Korea
| | - Sangkyung Choi
- Department of Ophthalmology, Veterans Health Service Medical Center, Seoul, Korea
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Gaynes JS, Micic C, Gaynes BI, Borgia JA. Quantitation of in vitro α-1 adrenergic receptor antagonist binding capacity to biologic melanin using tandem mass spectrometry. Curr Eye Res 2013; 38:1214-20. [PMID: 24047464 DOI: 10.3109/02713683.2013.822894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The purpose of this study was to develop methods to allow evaluation of the binding characteristics for a series of α-1 antagonists to biologically-derived melanin. METHODS Fresh bovine globes were used to obtain iridal and choroid/retinal pigment epithelial (CRPE) derived melanin. Binding characteristics of chloroquine, tamsulosin and doxazosin were then evaluated in vitro using tandem mass spectroscopy. RESULTS Tandem mass spectrometry-based assays were developed for three α-1 antagonists that provided linear assay ranges which spanned (minimally) 0.01-10 µg/mL, while exhibiting excellent inter-assay precision and accuracy. When applied to the evaluation of binding characteristics for iridal melanin, mean chloroquine and tamsulosin fractions were found to be 41.9 ± 14.2 pmoles mg(-1) and 25.34 ± 6.186 pmoles mg(-1), respectively. Mean iridal doxazosin binding was found to be 6.36 ± 2.19 pmoles mg(-1). Interestingly, mean levels of tamsulosin, but not doxazosin found bound to choroid/CRPE derived melanin approached that of chloroquine (27.91 µg/mL, 25.68 µg/mL and 5.94 µg/mL for chloroquine, tamsulosin and doxazosin, respectively). One way ANOVA for binding affinity for chloroquine, tamsulosin and doxazosin was statistically significant for both iridal and CRPE-derived melanin (p = 0.0012 and 0.0023), respectively. A Bonferroni post-hoc analysis demonstrated a statistically significant difference in the amount of binding between tamsulosin, doxazosin and chloroquine to iridal but not CRPE derived melanin (p < 0.05). CONCLUSIONS Tamsulosin appears to demonstrate melanin binding affinity which approaches chloroquine and exceeds doxazosin for both iridal and CRPE-derived bovine melanin.
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Affiliation(s)
- Jeffrey S Gaynes
- Departments of Biochemistry, Rush University Medical Center , Chicago, IL , USA
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Strittmatter F, Gratzke C, Stief CG, Hedlund P. Current pharmacological treatment options for male lower urinary tract symptoms. Expert Opin Pharmacother 2013; 14:1043-54. [DOI: 10.1517/14656566.2013.789020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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González Martín-Moro J, Muñoz Negrete F, Lozano Escobar I, Fernández Miguel Y. Intraoperative floppy-iris syndrome. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2013; 88:64-76. [PMID: 23433194 DOI: 10.1016/j.oftal.2011.09.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 07/07/2011] [Accepted: 09/11/2011] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Intraoperative-floppy iris syndrome (IFIS) has been recently described. It has been demonstrated that this new syndrome complicates cataract surgery. In this paper we have reviewed the syndrome, and offer practical information specially related to the origin and management of this syndrome and we offer practical information. MATERIAL AND METHODS A review of the related medical literature using PubMed and Cochrane databases. Combining the search terms tamsulosin, cataract, IFIS and intraoperative floppy iris syndrome, more than 200 articles were found. Eighty-two of them were obtained and analysed. In the remaining only the abstract could be studied. RESULTS The aetiological association between IFIS and tamsulosin (and to a lesser degree between IFIS and other alpha-antagonists) is well established. Other aetiological associations are doubtful. Most of the literature is centred on cataract surgery. However, a similar syndrome has been described during trabeculectomy. A possible association between these drugs and choroidal detachments has also been described. Undoubtedly tamsulosin treatment makes cataract surgery more difficult and increases the probability of intraoperative complications. Protocols to manage the syndrome have not yet been developed. Intracameral injection of alpha-adrenergic agonists seems to be useful. However there is no evidence of the usefulness of discontinuing the drug or using preoperative mydriatics. CONCLUSION The aetiological and clinic features of the syndrome are well established. More studies are needed to provide scientific evidence on the most appropriate way to cope with this syndrome.
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Management of intraoperative iris prolapse: stepwise practical approach. J Cataract Refract Surg 2012; 38:1845-52. [PMID: 22929088 DOI: 10.1016/j.jcrs.2012.08.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 02/22/2012] [Accepted: 03/11/2012] [Indexed: 11/22/2022]
Abstract
Iris prolapse is not an uncommon occurrence during cataract surgery. It usually occurs through the main incision during hydrodissection and is commonly associated with floppy-iris syndrome; however, it can manifest in cases with no known predisposition and can occur at any stage during surgery. The mechanism is explained by the Bernoulli principle and its effect on iris position during the movement of fluid within the eye. Predisposing factors are iris configuration, anterior chamber depth, and position and architecture of the corneal tunnel. Strategies for prevention and management include the use of pharmacological agents, ophthalmic viscosurgical devices, and iris retractors. These strategies can be augmented by alteration and adaptation of the surgeon's technique.
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Handzel DM, Briesen S, Rausch S, Kälble T. Cataract surgery in patients taking alpha-1 antagonists: know the risks, avoid the complications. DEUTSCHES ARZTEBLATT INTERNATIONAL 2012; 109:379-84. [PMID: 22690253 PMCID: PMC3371631 DOI: 10.3238/arztebl.2012.0379] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 11/30/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND The growing use of alpha-1 receptor antagonists in the treatment of benign prostatic hyperplasia (BPH) has created a new problem in ophthalmic surgery, the so-called intraoperative floppy iris syndrome (IFIS). This consists of a billowing iris, insufficient pupillary dilation with progressive intraoperative miosis, and protrusion of iris tissue through the tunnel and side port incision that are made for access to the anterior chamber during surgery. IFIS presents particular difficulties in cataract surgery which is carried out through the pupil with manipulations in the immediate vicinity of the iris. The complications range from poor visibility of the operative field to iris damage with the surgical instruments and to rupture of the posterior capsule, with loss of lens material into the vitreous body. METHODS Selective literature review. RESULTS Alpha-blockers have a direct effect on the alpha-receptors of the iris but also induce ultrastructural changes in the iridial stroma, leading to IFIS. The most important factor in avoiding complications of IFIS seems to be the ophthalmic surgeon's knowledge that the patient is taking an alpha-1 receptor antagonist. CONCLUSION A thorough medical history and an optimized information flow among all physicians treating the patient-the urologist, the family physician, and the ophthalmic surgeon-are essential for safe cataract surgery.
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Theodossiadis PG, Achtsidis V, Theodoropoulou S, Tentolouris N, Komninos C, Fountas KN. The effect of alpha antagonists on pupil dynamics: implications for the diagnosis of intraoperative floppy iris syndrome. Am J Ophthalmol 2012; 153:620-6. [PMID: 22265152 DOI: 10.1016/j.ajo.2011.09.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 09/20/2011] [Accepted: 09/20/2011] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess pupil dynamics quantitatively in relation to the use of α1-adrenoceptor antagonists, which contribute to the features of intraoperative floppy iris syndrome, using a new, hand-held, digital pupillometer. DESIGN Prospective case-control study. METHODS We studied 15 and 25 patients administered tamsulosin and alfuzosin, respectively, as well as 25 control patients. Resting pupil diameter and subsequent contraction, latency, constriction velocity, and dilation velocity were recorded using an electronic pupillometer. All pupil measurements were performed before and after pharmacologic dilation. RESULTS In predilation pupillary measurements, we detected a significant decrease in maximum pupillary diameter by 0.50±0.19 mm (P=.011) and in the mean percentage of diameter reduction after stimulation (5.23±2.42%, P=.035) in the tamsulosin group. Alfuzosin also induced a significant decrease in maximum pupillary diameter (0.49±0.17 mm, P=.005). Constriction velocity was significantly reduced by 0.70±0.20 m/s (P=.001) in the tamsulosin group and by 0.54±0.18 m/s (P=.004) in the alfuzosin group. In terms of postdilation measurements, maximum and minimum pupil diameters were reduced significantly only in the tamsulosin group (by 1.09±0.31 mm [P=.001] and by 0.89±0.36 mm [P=.016], respectively). CONCLUSIONS We describe a reliable, accurate, and rapid method to acquire quantitative pupil measurements and identify the tendency for intraoperative floppy iris syndrome before cataract surgery after the use of alfuzosin and tamsulosin. This investigation also analyzed the similarities and differences induced by the 2 drugs in predilation and postdilation pupil dynamics, demonstrating that tamsulosin is more potent than alfuzosin in inducing intraoperative floppy iris syndrome.
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Delgado Gallego S, Pérez Molto FJ, Cuadrado Escamilla JL, Soriano Lafarge A. Bloqueantes alfa-1 adrenérgicos y síndrome de iris flácido intraoperatorio. Aten Primaria 2012; 44:51-2. [DOI: 10.1016/j.aprim.2010.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 09/22/2010] [Accepted: 09/23/2010] [Indexed: 11/25/2022] Open
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Facio F, Kashiwabuschi R, Nishi Y, Leao R, McDonnell P, Burnett A. Benign prostatic hyperplasia. Clinical treatment can complicate cataract surgery. Int Braz J Urol 2011; 36:563-70. [PMID: 21044373 DOI: 10.1590/s1677-55382010000500006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2010] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To investigate the effects of alpha-1 adrenergic receptor antagonists for the treatment of benign prostatic hyperplasia (BPH) regarding potential risks of complications in the setting of cataract surgery. AIM To address recommendations, optimal control therapy, voiding symptoms and safety within the setting of cataract surgery. MATERIALS AND METHODS A comprehensive literature review was performed using MEDLINE with MeSH terms and keywords "benign prostatic hyperplasia", "intraoperative floppy iris syndrome", "adrenergic alpha-antagonist" and "cataract surgery". In addition, reference lists from identified publications were reviewed to identify reports and studies of interest from 2001 to 2009. RESULTS The first report of intraoperative floppy iris syndrome (IFIS) was observed during cataract surgery in patients taking systemic alpha-1 AR antagonists in 2005. It has been most commonly seen related to use of tamsulosin. Changes of medication and washout periods of up to 2 weeks have been attempted to reduce the risk of complications in the setting of cataract surgery. CONCLUSION Patients under clinical treatment for BPH should be informed about potential risks of this drug class so that it can be discuss with their healthcare providers, in particular urologist and ophthalmologist, prior to cataract surgery.
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Affiliation(s)
- Fernando Facio
- Department of Urology, Faculty of Medicine of Sao Jose do Rio Preto, Sao Paulo, Brazil.
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Casuccio A, Cillino G, Pavone C, Spitale E, Cillino S. Pharmacologic pupil dilation as a predictive test for the risk for intraoperative floppy-iris syndrome. J Cataract Refract Surg 2011; 37:1447-54. [DOI: 10.1016/j.jcrs.2011.02.030] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 02/22/2011] [Accepted: 02/24/2011] [Indexed: 11/27/2022]
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McVary KT, Roehrborn CG, Avins AL, Barry MJ, Bruskewitz RC, Donnell RF, Foster HE, Gonzalez CM, Kaplan SA, Penson DF, Ulchaker JC, Wei JT. Update on AUA Guideline on the Management of Benign Prostatic Hyperplasia. J Urol 2011; 185:1793-803. [PMID: 21420124 DOI: 10.1016/j.juro.2011.01.074] [Citation(s) in RCA: 714] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Kevin T. McVary
- American Urological Association Education and Research, Inc., Linthicum Maryland
| | - Claus G. Roehrborn
- American Urological Association Education and Research, Inc., Linthicum Maryland
| | - Andrew L. Avins
- American Urological Association Education and Research, Inc., Linthicum Maryland
| | - Michael J. Barry
- American Urological Association Education and Research, Inc., Linthicum Maryland
| | | | - Robert F. Donnell
- American Urological Association Education and Research, Inc., Linthicum Maryland
| | - Harris E. Foster
- American Urological Association Education and Research, Inc., Linthicum Maryland
| | - Chris M. Gonzalez
- American Urological Association Education and Research, Inc., Linthicum Maryland
| | - Steven A. Kaplan
- American Urological Association Education and Research, Inc., Linthicum Maryland
| | - David F. Penson
- American Urological Association Education and Research, Inc., Linthicum Maryland
| | - James C. Ulchaker
- American Urological Association Education and Research, Inc., Linthicum Maryland
| | - John T. Wei
- American Urological Association Education and Research, Inc., Linthicum Maryland
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Chatziralli IP, Sergentanis TN. Risk Factors for Intraoperative Floppy Iris Syndrome: A Meta-Analysis. Ophthalmology 2011; 118:730-5. [PMID: 21168223 DOI: 10.1016/j.ophtha.2010.08.039] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Revised: 08/11/2010] [Accepted: 08/17/2010] [Indexed: 11/28/2022] Open
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Simpson D, Munshi S, Dhar-Munshi S. Intra-operative floppy iris syndrome--a warning for geriatricians. Age Ageing 2010; 39:516. [PMID: 20488813 DOI: 10.1093/ageing/afq049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Alpha-Blockers and Intraoperative Floppy Iris Syndrome: Ophthalmic Adverse Events Following Cataract Surgery. Curr Urol Rep 2010; 11:242-8. [DOI: 10.1007/s11934-010-0119-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Schilit S, Benzeroual KE. Silodosin: a selective alpha1A-adrenergic receptor antagonist for the treatment of benign prostatic hyperplasia. Clin Ther 2010; 31:2489-502. [PMID: 20109995 DOI: 10.1016/j.clinthera.2009.11.024] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND Silodosin is a new alpha(1)-adrenergic receptor antagonist that is selective for the alpha(1A)-adrenergic receptor. It was approved by the US Food and Drug Administration (FDA) in 2008 for the treatment of lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). OBJECTIVE This article reviews the pharmacology, pharmacokinetics, clinical efficacy, adverse effects, drug interactions, and dosage and administration of silodosin in adult male patients with BPH. METHODS A search of MEDLINE (1950-October 8, 2009), International Pharmaceutical Abstracts (1970-October 8, 2009), and the Iowa Drug Information Service database (1966-October 8, 2009) was conducted using the terms silodosin, KMD-3213, benign prostatic hyperplasia, and alpha(1)-adrenergic receptor antagonist. Reports of research and review articles published in English were identified and evaluated, and the bibliographies of these articles were reviewed for additional relevant publications. A search of the FDA Web site was performed, and abstracts and posters presented at scientific meetings of the American Urological Association were reviewed. RESULTS By antagonizing alpha(1A)-adrenergic receptors in the prostate and urethra, silodosin causes smooth muscle relaxation in the LUT. Silodosin has greater affinity for the alpha(1A)-adrenergic receptor than for the alpha(1B)-adrenergic receptor (by a factor of 583), minimizing the propensity for blood pressure-related adverse effects mediated by alpha(1B) blockade. In 3 controlled clinical studies in patients with BPH-related LUTS (1 published; 2 presented in the prescribing information and published in a pooled analysis), patients receiving silodosin at a total daily dose of 8 mg had significant improvements in the International Prostate Symptom Score (IPSS) and maximum urinary flow rate (Q(max)) compared with those receiving placebo (both, P < 0.05). The most commonly reported adverse effect was abnormal or retrograde ejaculation (>22%), and the incidence of orthostatic hypotension was low (<3%). CONCLUSIONS In the small number of clinical trials reviewed, silodosin was associated with significant reductions in IPSS and Q(max) compared with placebo. To determine whether silodosin's selectivity for the alpha(1A)-adrenergic receptor translates into a clinical advantage relative to other available agents, long-term studies evaluating the comparative efficacy and tolerability of silodosin and other alpha(1)-blockers (specifically tamsulosin) are necessary.
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Affiliation(s)
- Sara Schilit
- International Drug Information Center, Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, Brooklyn, New York 11201, USA.
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Current world literature. Curr Opin Ophthalmol 2009; 21:81-90. [PMID: 19996895 DOI: 10.1097/icu.0b013e3283350158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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