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F.D. Ford, A.N. Carlson, T. Kim, N.A. Afshari; Analysis of the Association of Alpha Blocker Usage with Intraoperative Floppy Iris Syndrome . Invest. Ophthalmol. Vis. Sci. 2006;47(13):674.
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To further investigate the relationship between the usage of the alpha 1 antagonists, and the incidence of intraoperative floppy iris syndrome (IFIS).
All male patients who underwent cataract surgery during the twelve–month period from July 1,2004 through June 30, 2005 performed by the Cornea service at Duke University Eye Center were eligible for this study. Members of a three surgeon practice performed all operations. 376 eyes of male patients were operated on during this period. 331 eyes of 281 of those patients are included in this analysis. A retrospective chart review was performed. Patients that were taking any alpha1 antagonist were identified. Their pre–operative history, operative reports, and post–operative data were analyzed to assess the number of patients taking tamsulosin that experienced associated IFIS. The operative notes of those patients were reviewed to look for signs of IFIS. Patient information including age, race, estimated length of time on medication and co–morbidities were recorded to look for patterns of involvement. Additionally, the percentage of patients taking the systemic alpha blockers, terazosin and doxazosin, and the incidence of IFIS in these patients was analyzed.
5.3% (15/281) of the patients representing 4.5%(15/331) of the total eyes were found to have a history of tamsulosin usage. Of these patients, 60% (9/15) were found to have exhibited IFIS. This represents an overall prevalence of 3.2% of the total patient population. Patients taking other alpha blockers also made up 5% (14/281) of the total patient population. Only 7% (1/14) of these patients, 0.35% of the total patient population had findings suggestive of IFIS. The average age was 76 in the tamsusolin group and 74 in the other alpha blocker group. All patients were on their medications for at least a three month period with lengths ranging from 3 months to 8 years. Posterior capsule rupture was seen in two cases, one occurring in the tamsulosin group and one in the other alpha 1 blocker group.
Our results show a link between pre–operative systemic usage of tamsulosin and IFIS that was more evident than in those taking other alpha blockers. The parallel of IFIS and tamsulosin usage found in this study supports the theory that the drug is a causative agent for the syndrome. The limitations of the study stem from its retrospective nature. Prospective studies are necessary to determine exact incidence of IFIS for those taking any alpha blocker, as well as to determine what variables are significant for developing the syndrome.
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