title: Intraoperative floppy iris syndrome associated with alpha1-adrenergic receptor antagonists.
abstract: OBJECTIVE
  To describe intraoperative floppy iris syndrome (IFIS) in association with alpha(1)-adrenergic receptor (alpha(1)AR) antagonists by conducting a thorough literature review.
  
  
  METHODS
  Literature retrieval was accomplished by searching MEDLINE (2000-December 2007) using the terms intraoperative floppy iris syndrome (IFIS), adrenergic alpha-antagonist(s), tamsulosin, doxazosin, terazosin, and/or alfuzosin. In addition, reference lists from identified publications were reviewed to identify additional reports and studies of interest.
  
  
  METHODS
  All articles in English identified from data sources were reviewed for relevance and uniqueness prior to inclusion.
  
  
  RESULTS
  IFIS was first described in 2005 as a clinical triad observed during cataract surgery that includes fluttering and billowing of the iris stroma, propensity for iris prolapse, and constriction of the pupil. IFIS increases the risk of complications during cataract surgery. Numerous reports have linked IFIS to use of alpha(1)AR antagonists, most notably tamsulosin, which is prescribed for benign prostatic hyperplasia. Tamsulosin blocks prostatic alpha(1A)ARs but may also selectively block alpha(1A)ARs in the iris dilator muscle, preventing mydriasis during cataract surgery. Other alpha(1)AR antagonists, including terazosin, doxazosin, and alfuzosin, have also been linked to IFIS; however, their relationship to the syndrome is not as definitive. When ophthalmologists are aware of a patient's previous alpha(1)AR antagonist exposure, specific steps can be taken to reduce the risk of surgical complications. Corrective measures used during surgery have included iris expansion hooks, intracameral phenylephrine, and preoperative atropine.
  
  
  CONCLUSIONS
  IFIS is a clinical syndrome observed during cataract surgery reported in patients taking systemic alpha(1)AR antagonists. It has been most strongly linked to use of tamsulosin. Medication washout periods of up to 2 weeks and specific surgical procedures have been attempted to reduce risk of complications from alpha(1)AR antagonists in the setting of cataract surgery. Patients should be educated regarding potential risks of this drug class so that they can discuss them with their healthcare providers, specifically ophthalmologists, prior to cataract surgery.
authors: Veterans Affairs Medical Center, Iowa City, IA 52246, USA. matthewcantrell@uiowa.edu
authors: Matthew A
authors: MA
authors: Cantrell
authors: Heather R
authors: HR
authors: Bream-Rouwenhorst
authors: Andrew
authors: A
authors: Steffensmeier
authors: Phyllis
authors: P
authors: Hemerson
authors: Meaghan
authors: M
authors: Rogers
authors: Benton
authors: B
authors: Stamper
mesh_terms: D058668:Adrenergic alpha-1 Receptor Antagonists; D000317:Adrenergic alpha-Antagonists / Q000009:adverse effects*; D002387:Cataract Extraction; D006801:Humans; D007431:Intraoperative Complications / Q000139:chemically induced*; D007499:Iris Diseases / Q000139:chemically induced*; D013577:Syndrome
chemical_list: D058668:Adrenergic alpha-1 Receptor Antagonists; D000317:Adrenergic alpha-Antagonists