title: Prospective masked comparison of intraoperative floppy iris syndrome severity with tamsulosin versus alfuzosin.
abstract: OBJECTIVE
  To determine whether severe intraoperative floppy iris syndrome (IFIS) is more or equally likely with tamsulosin or alfuzosin.
  
  
  METHODS
  Prospective, masked, multicenter, cross-sectional study.
  
  
  METHODS
  Consecutive patients taking systemic tamsulosin or alfuzosin and scheduled for routine cataract surgery (case group) and patients with no history of systemic α1-antagonists scheduled for routine cataract surgery (control group).
  
  
  METHODS
  Phacoemulsification with intraocular lens implantation was performed and recorded on video. Intracameral phenylephrine or epinephrine, either by direct injection or placement in the irrigation bottle, was not permitted. Every surgical video subsequently was reviewed remotely by 2 masked investigators who diagnosed the presence or absence of IFIS and graded the severity of IFIS as follows: none, mild (billowing only), moderate (billowing and either iris prolapse or ≥2 mm of pupil constriction), or severe (billowing accompanied by iris prolapse and ≥2 mm of pupil constriction).
  
  
  METHODS
  Rate and severity of IFIS and surgical complication rate.
  
  
  RESULTS
  A total of 226 eyes (70 in the tamsulosin group, 43 in the alfuzosin group, and 113 in the control group) were enrolled. Severe IFIS was noted in 34.3% (24/70) of the tamsulosin eyes and in 16.3% (7/43) of the alfuzosin eyes compared with 4.4% (5/113) of the control eyes. The differences between each of the 3 groups were statistically significant. In the absence of epinephrine in the irrigation bottle, 12.4% of control eyes had moderate to severe IFIS. There were no instances of posterior capsular rupture or significant surgical complications in either the case or control groups.
  
  
  CONCLUSIONS
  Moderate to severe IFIS can occur in low-risk eyes when epinephrine is omitted from the irrigation bottle. Although both tamsulosin and alfuzosin significantly increase the risk of IFIS compared with patients without prior α1-antagonist intake, severe IFIS statistically was more likely with tamsulosin than with alfuzosin (P = 0.036). Patients with symptomatic benign prostatic hyperplasia and cataracts requiring a uroselective α1-antagonist may consider trying alfuzosin first.
authors: Department of Ophthalmology, University of California, San Francisco, San Francisco, California, and private practice, Los Altos, California. Electronic address: dceye@earthlink.net.
authors: David F
authors: DF
authors: Chang
authors: Private practice, Marin, California.
authors: John R
authors: JR
authors: Campbell
authors: Department of Ophthalmology, Bordeaux University Hospital, Bordeaux, France.
authors: Joseph
authors: J
authors: Colin
authors: Department of Ophthalmology, Bordeaux University Hospital, Bordeaux, France.
authors: Cedric
authors: C
authors: Schweitzer
mesh_terms: D058668:Adrenergic alpha-1 Receptor Antagonists / Q000009:adverse effects*; D000368:Aged; D003430:Cross-Sectional Studies; D004311:Double-Blind Method; D006801:Humans; D007431:Intraoperative Complications; D007499:Iris Diseases / Q000139:chemically induced* / Q000175:diagnosis; D019654:Lens Implantation, Intraocular; D008297:Male; D018918:Phacoemulsification; D011391:Prolapse; D011446:Prospective Studies; D011470:Prostatic Hyperplasia / Q000188:drug therapy; D011680:Pupil / Q000187:drug effects*; D011799:Quinazolines / Q000009:adverse effects*; D012307:Risk Factors; D012720:Severity of Illness Index; D013449:Sulfonamides / Q000009:adverse effects*; D000077409:Tamsulosin; D014741:Video Recording
chemical_list: D058668:Adrenergic alpha-1 Receptor Antagonists; D011799:Quinazolines; D013449:Sulfonamides; C047638:alfuzosin; D000077409:Tamsulosin