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Published Online, 25 March 2008, www.theannals.com, DOI 10.1345/aph.1K679.
 The Annals of Pharmacotherapy: Vol. 42, No. 4, pp. 558-563. DOI 10.1345/aph.1K679
© 2008 Harvey Whitney Books Company.
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DRUG INFORMATION ROUNDS

Intraoperative Floppy Iris Syndrome Associated with {alpha}1-Adrenergic Receptor Antagonists

Matthew A Cantrell, PharmD

Clinical Pharmacy Specialist, Veterans Affairs Medical Center, Iowa City, IA; Assistant Professor (Clinical), College of Pharmacy, University of Iowa, Iowa City

Heather R Bream-Rouwenhorst, PharmD BCPS

Clinical Pharmacy Specialist-Surgery/Transplant, Veterans Affairs Medical Center, Iowa City; Assistant Professor (Clinical), College of Pharmacy, University of Iowa

Andrew Steffensmeier, MD

Resident Physician, Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa

Phyllis Hemerson, PharmD

PGY-1-Ambulatory Care Resident, Veterans Affairs Medical Center, Iowa City; Adjunct Instructor, College of Pharmacy, University of Iowa

Meaghan Rogers, PharmD

PGY-1-Ambulatory Care Resident, Veterans Affairs Medical Center, Iowa City; Adjunct Instructor, College of Pharmacy, University of Iowa

Benton Stamper, PharmD

PGY-1-Ambulatory Care Resident, Veterans Affairs Medical Center, Iowa City; Adjunct Instructor, College of Pharmacy, University of Iowa

Reprints: Dr. Cantrell, Veterans Affairs Medical Center, 601 Highway 6 W., Iowa City, IA 52246, fax 319/887-4951, matthew-cantrell{at}uiowa.edu

OBJECTIVE: To describe intraoperative floppy iris syndrome (IFIS) in association with {alpha}1-adrenergic receptor ({alpha}1AR) antagonists by conducting a thorough literature review.

DATA SOURCES: 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.

STUDY SELECTION AND DATA EXTRACTION: All articles in English identified from data sources were reviewed for relevance and uniqueness prior to inclusion.

DATA SYNTHESIS: 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}1AR antagonists, most notably tamsulosin, which is prescribed for benign prostatic hyperplasia. Tamsulosin blocks prostatic {alpha}1AARs but may also selectively block {alpha}1AARs in the iris dilator muscle, preventing mydriasis during cataract surgery. Other {alpha}1AR 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}1AR 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}1AR 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}1AR 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.

Key Words: {alpha}-adrenergic antagonists, alfuzosin, doxazosin, intraoperative floppy iris syndrome (IFIS), tamsulosin, terazosin

Published Online, March 25, 2008. www.theannals.com, DOI 10.1345/aph.1K679




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