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Wang YH, Huang LC, Tsai SHL, Chen YJ, Wu CL, Kang YN. Risk of intraoperative floppy iris syndrome among selective alpha-1 blockers—A consistency model of 6,488 cases. Front Med (Lausanne) 2022; 9:941130. [PMID: 36111121 PMCID: PMC9468244 DOI: 10.3389/fmed.2022.941130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/10/2022] [Indexed: 12/03/2022] Open
Abstract
Selective α1-blockers are commonly administered to patients with lower urinary tract syndrome and benign prostatic hyperplasia, but may increase the risk of intraoperative floppy iris syndrome (IFIS). The purpose of this study aimed to clarify the risk of IFIS among various selective α1-blockers. Four databases were searched for prospective studies comparing alpha-1-antagonists. Data were pooled using the consistency model, and used risk ratio (RR) and mean difference (MD) for IFIS and pupil diameter, respectively. This study finally included 25 prospective comparative studies. Based on 51 direct comparisons with 6488 cases, risks of IFIS in patients who received tamsulosin [RR, 13.85; 95% confidence interval (CI): 7.34 to 26.11], terazosin (RR, 8.94; 95% CI 2.88 to 27.74), alfuzosin (RR, 7.73; 95% CI: 3.05 to 19.62), and doxazosin (RR, 3.88; 95% CI: 1.13 to 13.28) were significantly higher than those did not receive α1-antagonists. Based on 11 direct comparisons with 564 cases, as compared to no α1-antagonists, patients who received tamsulosin (MD, −0.36; 95% CI: −0.71 to −0.01) and alfuzosin (MD, −0.34; 95% CI: −0.62 to −0.07) showed smaller pupil diameter under mesopic light levels, while those received silodosin did not show significantly smaller mesopic pupil diameter than people without α1-antagonists. IFIS seems to be inevitable with the usage of α1-antagonists, and tamsulosin needs to be cautious due to the significantly higher risk of severe IFIS. With regard to silodosin, there is no strong evidence to support the uses of italthough it does not significantly decrease mesopic pupil diameter.
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Affiliation(s)
- Ya-Hui Wang
- Department of Ophthalmology, Taipei Municipal Wanfang Hospital, Taipei, Taiwan
- School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Liang-Chen Huang
- Division of Urology, Department of Surgery, En Chu Kong Hospital, New Taipei City, Taiwan
| | - Sung Huang Laurent Tsai
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ying-Jen Chen
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Geriatric and General Internal Medicine Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chien-Liang Wu
- Department of Ophthalmology, Taipei Municipal Wanfang Hospital, Taipei, Taiwan
- School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-No Kang
- Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Health Care Management, College of Health Technology, National Taipei University of Nursing Health Sciences, Taipei, Taiwan
- *Correspondence: Yi-No Kang
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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: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Chatziralli IP, Peponis V, Parikakis E, Maniatea A, Patsea E, Mitropoulos P. Risk factors for intraoperative floppy iris syndrome: a prospective study. Eye (Lond) 2016; 30:1039-44. [PMID: 27367744 DOI: 10.1038/eye.2016.122] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 04/15/2016] [Indexed: 11/09/2022] Open
Abstract
PurposeTo evaluate risk factors for intraoperative floppy iris syndrome (IFIS) in patients undergoing phacoemulsification.MethodsParticipants in the study were 1274 consecutive patients, who underwent routine phacoemulsification cataract surgery. The following data were recorded and evaluated as possible risk factors: ophthalmological conditions, axial length of the eye, sociodemographic features, clinical data (hypertension and diabetes mellitus), medications being taken at the time of surgery, and duration of their intake. Cases were characterized intraoperatively as IFIS and non-IFIS. Univariate and multivariate logistic regression analysis were performed.ResultsIFIS was observed in 63/1274 eyes (4.9%, 95% CI: 3.9-6.7%). Current use of tamsulosin, alfuzosin, terazosin, benzodiazepines, quetiapine, and finasteride, as well as hypertension, were all independently associated with IFIS. Significant associations were noted for male sex, rivastigmine, and short axial length, which did not reach significance at the multivariate analysis. Duration of α-blockers intake was not found to be associated with IFIS.ConclusionApart from the well-established associations with α-blockers, this prospective study points to benzodiazepines, quetiapine, finasteride, and hypertension as potential risk factors for IFIS. Short axial length and rivastigmine were significantly associated with IFIS only at the univariate analysis.
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Affiliation(s)
- I P Chatziralli
- 2nd Department of Ophthalmology, Ophthalmiatrion Athinon, Athens, Greece
| | - V Peponis
- 2nd Department of Ophthalmology, Ophthalmiatrion Athinon, Athens, Greece
| | - E Parikakis
- 2nd Department of Ophthalmology, Ophthalmiatrion Athinon, Athens, Greece
| | - A Maniatea
- 2nd Department of Ophthalmology, Ophthalmiatrion Athinon, Athens, Greece
| | - E Patsea
- 2nd Department of Ophthalmology, Ophthalmiatrion Athinon, Athens, Greece
| | - P Mitropoulos
- 2nd Department of Ophthalmology, Ophthalmiatrion Athinon, Athens, Greece
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Storr-Paulsen A, Jørgensen JS, Norregaard JC, Thulesen J. Corneal endothelial cell changes after cataract surgery in patients on systemic sympathetic α-1a antagonist medication (tamsulosin). Acta Ophthalmol 2014; 92:359-63. [PMID: 23617291 DOI: 10.1111/aos.12140] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to assess the incidence of intraoperative floppy iris syndrome (IFIS) and the morphology of the corneal endothelium after cataract extraction in Caucasian male patients exposed to the α-1a adrenergic receptor antagonist tamsulosin. METHODS In a clinical prospective study, 23 male patients (23 eyes) treated with tamsulosin due to benign prostatic hyperplasia and 25 male patients (25 eyes) with no tamsulosin treatment had cataract surgery. The divide-and-conquer technique was used with the Infinity OZil(®) machine. A combination of Healon and Healon5 was used in all patients, but the use of additional Vision Blue, iris retractors or intracameral phenylephrine in the tamsulosin group was at the discretion of the surgeon. The endothelial cell density, variation in endothelial cell size (CV), percentage of hexagonal cells and central corneal thickness (CCT) were recorded at baseline and at 3 months postoperatively. RESULTS In the tamsulosin-treated group, 19 of 23 eyes (83%) developed IFIS, compared with no IFIS in the control group. Compared with the control group, the tamsulosin group showed significantly less dilatation at the start of the operation, significant miosis during surgery and significantly greater corneal endothelial cell loss 3 months postoperatively (12% versus 3%; p< 0.001). CONCLUSION Intraoperative floppy iris syndrome during cataract surgery is significantly associated with tamsulosin-treated male patients. Patients on tamsulosin showed less preoperative dilatation, significant miosis during surgery, and had significantly greater postoperative endothelial cell loss compared with nontreated patients despite recommended precautions.
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Affiliation(s)
- Allan Storr-Paulsen
- Department of Ophthalmology, Frederiksberg University Hospital, Frederiksberg, DenmarkRoskilde Eye Clinic, Roskilde, Denmark
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Jan Teper S, Dobrowolski D, Wylegala E. Complications of cataract surgery in patients with BPH treated with alpha 1A-blockers. Cent European J Urol 2011; 64:62-6. [PMID: 24578865 PMCID: PMC3921715 DOI: 10.5173/ceju.2011.02.art2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 01/24/2011] [Accepted: 02/03/2011] [Indexed: 11/22/2022] Open
Abstract
The prevalence of benign prostate hyperplasia (BPH) and cataract increases with age. Both diseases may develop concomitantly and may affect almost 50% of elderly men as comorbidities. Cataract is treated surgically and it has been reported that there may be an association between use of alpha-blockers for BPH, particularly alpha1A-adrenergic receptor selective drugs, and complications of cataract surgery known as Intraoperative Floppy Iris Syndrome (IFIS). The article reviews literature published on this topic and provides recommendations on how to reduce incidence of iatrogenic IFIS or its severity and outcomes in patients with BPH.
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Affiliation(s)
- Slawomir Jan Teper
- Department of Ophthalmology, District Railway Hospital in Katowice, Poland
| | | | - Edward Wylegala
- Department of Ophthalmology, District Railway Hospital in Katowice, Poland
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