Document Detail


Factors associated with intraoperative floppy iris syndrome.
MedLine Citation:
PMID:  19243826     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To identify factors associated with intraoperative floppy iris syndrome (IFIS) in patients undergoing routine phacoemulsification. DESIGN: Comparative case series. PARTICIPANTS: Analysis of 899 eyes of 660 patients undergoing routine cataract surgery. METHODS: All routine cases of cataract extraction with posterior chamber intraocular lens implantation between September 1, 2005, and August 31, 2006, were documented. Pertinent patient information, including age, gender, race, medical history, and current medication use (including tamsulosin [Flomax, Boehringer-Ingelheim, Ingelheim, Germany], other alpha(1)-antagonists, angiotensin antagonists, anticholinergics, cholinergic agonists, muscle relaxants, nitric oxide donors, and saw palmetto), were collected at the time of surgery. A telephone survey was used to determine previous use of tamsulosin, other alpha(1)-antagonists, and saw palmetto. Cases were identified intraoperatively as IFIS or non-IFIS following the triad of criteria developed by Chang and Campbell. MAIN OUTCOME MEASURES: Presence of IFIS associated with medication use and medical history. RESULTS: Analysis showed IFIS in 27 patients (4.1%) representing 33 eyes (3.7%). Tamsulosin use (P<0.001) and history of alpha(1)-antagonist use other than tamsulosin (P = 0.01) were shown to strongly correlate with IFIS in our study. Hypertension was noted to be a significant variable via multivariable generalized estimating equations analysis (P = 0.04) with a prevalence of 75.8% in patients with IFIS versus 56.4% in patients without IFIS. Saw palmetto showed a slight, but statistically insignificant, trend that current use or history of use may be associated with IFIS. There were no cases of posterior capsular rupture or vitreous loss. CONCLUSIONS: Exposure to tamsulosin highly correlates with IFIS. Use of other alpha(1)-antagonists is also associated with IFIS. Several patients in our series were identified to have IFIS with no history of alpha(1)-antagonist use, indicating that other etiologic factors, or a combination of factors, can also elicit this response. Multivariable regression analysis shows no proven relationship between IFIS and individual use of angiotensin antagonists, anticholinergics, cholinergic agonists, muscle relaxants, nitric oxide donors, or saw palmetto, and diabetes or congestive heart failure.
Authors:
Kristiana D Neff; Helga P Sandoval; Luis E Fernández de Castro; Amy S Nowacki; David T Vroman; Kerry D Solomon
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2009-02-25
Journal Detail:
Title:  Ophthalmology     Volume:  116     ISSN:  1549-4713     ISO Abbreviation:  Ophthalmology     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-04-06     Completed Date:  2009-04-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802443     Medline TA:  Ophthalmology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  658-63     Citation Subset:  IM    
Affiliation:
Department of Ophthalmology, Storm Eye Institute, Charleston, South Carolina 29425, USA.
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MeSH Terms
Descriptor/Qualifier:
Adrenergic alpha-Antagonists / adverse effects*
Aged
Aged, 80 and over
Female
Humans
Intraoperative Complications*
Iris / drug effects*
Iris Diseases / chemically induced*
Lens Implantation, Intraocular
Male
Middle Aged
Phacoemulsification
Receptors, Adrenergic, alpha-1 / antagonists & inhibitors*
Risk Factors
Sulfonamides / adverse effects*
Syndrome
Grant Support
ID/Acronym/Agency:
EY-014793/EY/NEI NIH HHS
Chemical
Reg. No./Substance:
0/Adrenergic alpha-Antagonists; 0/Receptors, Adrenergic, alpha-1; 0/Sulfonamides; 106133-20-4/tamsulosin

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