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P.-M. Palmiero, T. S. Prata, C. V. De Moraes, Z. Sbeity, C. Tello, J. M. Liebmann, R. Ritch; Iris Structural Alterations in Patients Using Alpha-Adrenergic Blocking Agents. Invest. Ophthalmol. Vis. Sci. 2009;50(13):6206.
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To assess iris structural alterations associated with intraoperative floppy iris syndrome (IFIS) in patients using systemic -1-adrenergic receptor antagonists (-1ARA).
We prospectively imaged 51 men currently or previously treated with systemic -1ARA (29 treated and 22 untreated subjects) using slit-lamp-adapted optical coherence tomography (SL-OCT) under standardized lighting conditions. Eyes with any ocular condition or use of medication that could alter iris morphology were excluded. Iris thickness was analyzed in a masked fashion at the dilator muscle region (DMR, measured at half the distance between the scleral spur and pupillary margin) and at the sphincter muscle region (SMR, 0.75 mm from the pupillary margin). The ratio between the DMR/SMR was calculated to compensate for possible intersubject variability. Photopic pupillary diameter was calculated and compared in both groups.
Most treated patients were on tamsulosin (27/29). Mean age was similar in study and control groups (70.6±7.6 vs 67.1±9.1 yr, p=0.061). Photopic pupil diameter was reduced in the study group (mean: 2.06 ± 0.5 vs 2.5 ± 0.6 mm, p=0.001). SMR was similar between groups (p=0.53). Significantly lower values were found in treated subjects for the DMR and the DMR/SMR ratio (p<0.001), which also remained significant after adjusting for pupil diameter (p<0.001). Multiple regression analysis showed that a longer duration of -1ARA treatment correlated to a reduced DMR/SMR ratio (p=0.001, r=0.47).These differences appear to be related to the duration of drug exposure and provide evidence of structural alterations to the iris dilator muscle from this class of agents.
Patients using systemic -1ARA have significantly lower values of DMR thickness, DMR/SMR ratio, and smaller pupil diameter when compared to age-matched controls.
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