Incidence, clinical findings and management of intraoperative floppy iris syndrome associated with tamsulosin.
OBJECTIVE
To determine the risk ratios and incidence of intraoperative floppy iris syndrome (IFIS) during cataract surgery in patients using tamsulosin, and to assess management strategies for IFIS.


METHODS
We performed a non-randomized, observational, prospective study, in which 594 eyes of 579 patients undergoing cataract surgery were enrolled. Surgeons were masked to the patients' drug history. Usage or non-usage of tamsulosin, duration of tamsulosin use, presence or absence of IFIS, management of IFIS and intraoperative complications were recorded in the patients' theatre notes.


RESULTS
Twelve of 15 (80%) IFIS patients were taking systemic tamsulosin. Twelve of 23 (52%) patients using tamsulosin showed features of IFIS. The odds ratios (ORs) and relative risk (RR) ratios show strong positive correlations between tamsulosin use and IFIS. The ORs and RR ratios and the 95% confidence intervals (CIs) are as follows: OR 206.5 (95% CI 50.9-836.5); RR 99.3 (95% CI 30.0-327.8). There were no statistically significant differences between patients with or without IFIS, who were using tamsulosin, in terms of age or duration of tamsulosin use (p > 0.05). Seven eyes (46.6%) with IFIS were successfully managed with epinephrine. Eight eyes (53.4%) with IFIS needed iris hooks.


CONCLUSIONS
Patients using tamsulosin appear to be at high risk of IFIS during cataract surgery. The occurrence of IFIS may not be affected by duration of tamsulosin use or age. Epinephrine may be effective in approximately 50% of eyes with IFIS. The iris hook procedure represents an effective management strategy in IFIS.
Keklikci
Ugur
U
Department of Ophthalmology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey. ukeklikci@yahoo.com
Isen
Kenan
K
Unlu
Kaan
K
Celik
Yusuf
Y
Karahan
Mine
M
D000287:Administration, Topical; D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage; D000317:Adrenergic alpha-Antagonists / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002387:Cataract Extraction / Q000009:adverse effects*; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000139:chemically induced*; D007499:Iris Diseases / Q000209:etiology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D013449:Sulfonamides / Q000009:adverse effects*; D000077409:Tamsulosin
D000316:Adrenergic alpha-Agonists; D000317:Adrenergic alpha-Antagonists; D013449:Sulfonamides; D000077409:Tamsulosin; D004837:Epinephrine