Intraoperative floppy-iris syndrome associated with α₁-adrenoreceptors

Purpose

To compare the incidence of intraoperative floppy-iris syndrome (IFIS) in men exposed to tamsulosin and men exposed to alfuzosin and evaluate the effect of IFIS on the complication rate of cataract surgery.

Setting

Tertiary care hospital, Chicoutimi, Quebec, Canada.

Methods

The medical charts of 64 men (92 eyes) who had phacoemulsification cataract surgery between June 2005 and July 2006 and reported having used tamsulosin or alfuzosin at their initial visit for cataract evaluation were reviewed. The presence or absence of IFIS, potential confounding clinical covariates, duration of surgery, and complications were noted. The history of taking an α₁-antagonist was verified. To address the main objective of the study, only patients who had exclusively used tamsulosin or alfuzosin were included. For the secondary objective, all eligible patients were included even if they had received more than one α₁-antagonist in the past.

Results

Of men exclusively exposed to tamsulosin (22) or alfuzosin (13), 86.4% and 15.4%, respectively, developed IFIS (P<.001). The adjusted odds ratio of IFIS in patients exposed to tamsulosin compared to those exposed to alfuzosin was 32.15 (95% confidence interval, 2.74-377.11). Eyes with IFIS had a higher risk for complications (focal iris stromal atrophy, transient postoperative hypertension, major iris trauma, posterior capsule break with vitreous loss, zonular dehiscence, postoperative cystoid macular edema) than eyes without IFIS (P<.001).

Conclusions

Men exposed to tamsulosin had a significantly higher risk for developing IFIS than men exposed to alfuzosin. Intraoperative floppy-iris syndrome significantly increased the complication rate of cataract surgery.