title: ASCRS White Paper: clinical review of intraoperative floppy-iris syndrome.
abstract: Intraoperative floppy-iris syndrome (IFIS) is associated with the use of systemic alpha(1)-antagonists, and tamsulosin in particular. The incidence and severity of IFIS are variable; however, the syndrome is associated with a higher rate of cataract surgical complications, especially when the condition is not recognized or anticipated. Questioning cataract patients preoperatively about current or previous use of alpha(1)-antagonists is therefore important. Intraoperative floppy-iris syndrome surgical management strategies include pharmacologic measures, the use of high-viscosity ophthalmic viscosurgical devices, and mechanical dilating devices. However, sphincterotomies and pupil stretching are ineffective. Whether used alone or in combination, these small-pupil techniques improve the surgical success rate in these cases. Stopping the alpha(1)-antagonist preoperatively is of questionable value.
authors.affiliation: dceye@earthlink.net
authors.forename: David F
authors.initials: DF
authors.lastname: Chang
authors.forename: Rosa
authors.initials: R
authors.lastname: Braga-Mele
authors.forename: Nick
authors.initials: N
authors.lastname: Mamalis
authors.forename: Samuel
authors.initials: S
authors.lastname: Masket
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Miller
authors.forename: Louis D
authors.initials: LD
authors.lastname: Nichamin
authors.forename: Richard B
authors.initials: RB
authors.lastname: Packard
authors.forename: Mark
authors.initials: M
authors.lastname: Packer
mesh_terms: D058668:Adrenergic alpha-1 Receptor Antagonists; D000317:Adrenergic alpha-Antagonists / Q000009:adverse effects*; D002387:Cataract Extraction; D006801:Humans; D007431:Intraoperative Complications; D007499:Iris Diseases / Q000139:chemically induced* / Q000378:metabolism / Q000517:prevention & control; D008297:Male; D009130:Muscle, Smooth / Q000378:metabolism; D011470:Prostatic Hyperplasia / Q000188:drug therapy; D011680:Pupil / Q000187:drug effects*; D018340:Receptors, Adrenergic, alpha-1 / Q000378:metabolism; D013449:Sulfonamides / Q000009:adverse effects*; D013577:Syndrome; D000077409:Tamsulosin
chemical_list: D058668:Adrenergic alpha-1 Receptor Antagonists; D000317:Adrenergic alpha-Antagonists; D018340:Receptors, Adrenergic, alpha-1; D013449:Sulfonamides; D000077409:Tamsulosin