Urology
Volume 76, Issue 2 , Pages 272-276 , August 2010

Intraoperative Floppy Iris Syndrome: Facts for the Urologist

  • Ozgur Yaycioglu

      Affiliations

    • Department of Urology, Baskent University School of Medicine, Adana, Turkey
    • Corresponding Author InformationReprint requests: Ozgur Yaycioglu, M.D., F.E.B.U., Department of Urology, Baskent University School of Medicine, Adana Clinic and Research Center, Dadaloglu Mah. 39, Sokak No. 6, Yuregir, Adana 01250 Republic of Turkey
    • ,
  • Rana Altan-Yaycioglu

      Affiliations

    • Department of Ophthalmology, Baskent University School of Medicine, Adana, Turkey

Received 23 December 2009 ,Accepted 17 January 2010.

References 

  1. Chute CG, Panser LA, Girman CJ, et al. The prevalence of prostatism: a population-based survey of urinary tract symptoms. J Urol. 1993;150:85–89
  2. Saigal CS, Movassaghi M, Pace J, et al. Economic evaluation of treatment strategies for benign prostatic hyperplasia—is medical therapy more costly in the long run?. J Urol. 2007;177:1463–1467
  3. Sung JC, Curtis LH, Schulman KA, et al. Geographic variations in the use of medical and surgical therapies for benign prostatic hyperplasia. J Urol. 2006;175:1023–1027
  4. Souverein PC, Erkens JA, de la Rosette J, et al. Drug treatment for benign prostatic hyperplasia and hospital admission for BPH-related surgery. Eur Urol. 2003;43:528–534
  5. Williams A, Sloan FA, Lee PP. Longitudinal rates of cataract surgery. Arch Ophthalmol. 2006;124:1308–1314
  6. Michel MC, Kenny B, Schwinn DA. Classification of α1-adrenocepror subtypes. Naunyn Schmiedebergs Arch Pharmacol. 1995;352:1–10
  7. Hawrylyshyn KA, Michelotti GA, Coge F, et al. Update on human alpha1-adrenoceptor subtype signalling and genomic organization. Trends Pharmacol Sci. 2004;25:449–455
  8. Roehrborn CG, Schwinn DA. α-1 Adrenergic receptors and their inhibitors in lower urinary tract symptoms and benign prostatic hyperplasia. J Urol. 2004;171:1029–1035
  9. Schwinn DA, Afshari NA. α1-Adrenergic receptor antagonists and the iris: new mechanistic insights into floppy iris syndrome. Surv Ophthalmol. 2006;51:501–512
  10. Andersson KA. α-Adrenoceptors and benign prostatic hyperplasia: basic principles for treatment with α-adrenoceptor antagonists. World J Urol. 2002;19:390–396
  11. Yu Y, Koss MC. α1A-Adrenoceptors mediate sympathetically evoked pupillary dilation in rats. J Pharmacol Exp Ther. 2002;300:521–525
  12. Yu Y, Koss MC. Studies of α adrenoceptor antagonists on sympathetic mydriasis in rabbits. J Ocul Pharmacol Ther. 2003;19:255–263
  13. Chang DF, Campbell JR. Intraoperative floppy iris syndrome associated with tamsulosin (Flomax). J Cataract Refract Surg. 2005;31:664–673
  14. Schwinn DA, Afshari NA. α-1 Adrenergic antagonists and floppy iris syndrome: tip of the iceberg?. Ophthalmology. 2005;112:2059–2060
  15. Bell CM, Hatch WV, Fischer WV, et al. Association between tamsulosin and serious ophthalmic adverse events in older men following cataract surgery. JAMA. 2009;301:1991–1996
  16. Chang DF, Osher RH, Wang L, et al. A prospective multicenter evaluation of cataract surgery in patients taking tamsulosin (Flomax). Ophthalmology. 2007;114:957–964
  17. Keklikci U, Isen K, Unlu K, et al. Incidence, clinical findings and management of intraoperative floppy iris syndrome associated with tamsulosin. Acta Ophthalmol. 2009;87:306–309
  18. Neff KD, Sandoval HP, de Castro LEF, et al. Factors associated with intraoperative floppy iris syndrome. Ophthalmology. 2009;116:658–663
  19. Oshika T, Ohashi Y, Inamura M, et al. Incidence of intraoperative floppy iris syndrome in patients on either systemic or topical α1-adrenoceptor antagonists. Am J Ophthalmol. 2007;143:150–151
  20. Cheung CM, Awan MA, Peh KK, et al. Comment on: incidence of intraoperative floppy iris syndrome in patients on either systemic or topical α1-adrenoceptor antagonists. Am J Ophthalmol. 2007;143:1070–1071
  21. Takmaz T, Can I. Clinical features, complications, and incidence of intraoperative floppy iris syndrome in patients taking tamsulosin. Eur J Ophthalmol. 2007;17:909–913
  22. Altan-Yaycioglu R, Gedik S, Pelit A, et al. Clinical factors associated with floppy iris signs: a prospective study from two centers. Ophthalmic Surg Lasers Imaging. 2009;40:232–238
  23. Blouin MC, Blouin J, Perreault S, et al. Intraoperative floppy-iris syndrome associated with α1-adrenoceptors comparison of tamsulosin and alfuzosin. J Cataract Refract Surg. 2007;33:1227–1234
  24. Chadha V, Borooah S, Tey A, et al. Floppy iris behaviour during cataract surgery: associations and variations. Br J Ophthalmol. 2007;91:40–42
  25. Ugarte M, Leong T, Rassam S, et al. Intraoperative floppy-iris syndrome, α1-adrenergic antagonists, and chronic intake of mianserin: is there an association?. J Cataract Refract Surg. 2007;33:170–171
  26. Pringle E, Packard R. Antipsychotic agent as a n etiologic agent of IFIS. J Cataract Refract Surg. 2005;31:2240–2241
  27. Calotti F, Steen D. Labetalol causing intraoperative floppy-iris syndrome. J Cataract Refract Surg. 2007;33:170
  28. Yeu E, Grostern R. Saw palmetto and intraoperative floppy-iris syndrome. J Cataract Refract Surg. 2007;33:927–928
  29. Issa SA, Dagres E. Intraoperative floppy-iris syndrome and finasteride intake. J Cataract Refract Surg. 2007;33:2142–2143
  30. Srinivasan S, Radomski S, Chung J, et al. Intraoperative floppy-iris syndrome during cataract surgery in men using alpha-blockers for benign prostatic hypertrophy. J Cataract Refract Surg. 2007;33:1826–1827
  31. Palea S, Chang DF, Rekik M, et al. Comparative effect of alfuzosin and tamsulosin on the contractile response of isolated rabbit prostatic and iris dilator smooth muscles: possible model for intraoperative floppy-iris syndrome. J Cataract Refract Surg. 2008;34:489–496
  32. Takmaz T, Can I. Intraoperative floppy-iris syndrome: do we know everything about it?. J Cataract Refract Surg. 2007;33:1110–1112
  33. Parssinen O, Leppanen E, Keski-Rahkonen P, et al. Influence of tamsulosin on the iris and its implications for cataract surgery. Invest Ophthalmol Vis Sci. 2006;47:3766–3771
  34. Goseki T, Shimizu K, Ishikawa H, et al. Possible mechanism of intraoperative floppy iris syndrome: a clinicopathological study. Br J Ophthalmol. 2008;92:1156–1158
  35. Prata TS, Palmiero PM, Angelilli A, et al. Iris morphologic changes related to α1 adrenergic receptor antagonists implication for intraoperative floppy iris syndrome. Ophthalmology. 2009;116:877–881
  36. Shah N, Tendulkar M, Brown R. Should we anticipate intraoperative floppy iris syndrome (IFIS) even with very short history of tamsulosin?. Eye. 2009;23:740
  37. Thiyagarajan M. α-Adrenoceptor antagonists in the treatment of benign prostate hyperplasia. Pharmacologist. 2002;65:119–128
  38. Andersson KE. α-Adrenoceptors and benign prostatic hyperplasia: basic principles for treatment with α-adrenoceptor antagonists. World J Urol. 2002;19:390–396
  39. Altan-Yaycioglu R, Yaycioglu O, Gul U, et al. The effects of two systemic α1-adrenergic blockers on pupil diameter: a prospective randomized single-blind study. Naunyn Schmiedebergs Arch Pharmacol. 2007;375:199–203
  40. Altan-Yaycioglu R, Yaycioglu O, Tufan H, et al. The effects of systemic alpha-1 adrenergic antagonists on pupil diameter in rats. Curr Eye Res. 2007;32:217–221
  41. Chang DF, Baraga-Mele R, Mamalis N, et al. Clinical experience with intraoperative floppy-iris syndrome: results of the 2008 ASCRS member survey. J Cataract Refract Surg. 2008;34:1201–1209
  42. Nguyen DQ, Sebastian RT, Kyle GS. Experience of the intraoperative floppy iris syndrome in the United Kingdom. Surgery. 2007;21:443–444
  43. Lawrentschuk N, Bylsma GW. Intraoperative “floppy iris” syndrome and its relationship to tamsulosin: a urologist's guide. BJU Int. 2006;97:2–4
  44. Nguyen DQ, Sebastian RT, Philip J. Intraoperative floppy iris syndrome associated with tamsulosin. BJU Int. 2006;97:197
  45. Leibovici D, Bar-Kana Y, Zadok D, et al. Association between tamsulosin and intraoperative “floppy-iris” syndrome. IMAJ. 2009;11:45–49
  46. Chang DF, Braga-Mele R, Mamalis N, et al. ASCRS Cataract Clinical Committee ASCRS White Paper: clinical review of intraoperative floppy-iris syndrome. J Cataract Refract Surg. 2008;34:2153–2162
  47. Sallam A, Gunasekera V, Kashani S, et al. Awareness of IFIS among primary care physicians. J Cataract Refract Surg. 2008;34:882

PII: S0090-4295(10)00098-1

doi: 10.1016/j.urology.2010.01.025

Urology
Volume 76, Issue 2 , Pages 272-276 , August 2010

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