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S. Bakalian, S. K. Lindley, M. Elhilali, B. F. Fernandes, D. Faingold, M. N. Burnier; Intraoperative Floppy Iris Syndrome and Cataract Surgery Complications Associated With the Use of Tamsulosin. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5412.
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Intra-operative floppy-iris syndrome (IFIS) is a recently described condition associated with cataract extraction in patients using different types of alpha-blockers for the treatment of benign prostatic hyperplasia (BPH). The aim of this study was to evaluate the incidence of IFIS and other operative findings in patients using Tamsulosin versus controls.
A prospective case control study of 233 male patients who underwent cataract surgery. Patients were divided into 2 groups: patients on Tamsulosin (n=39) and controls (n=194). Data including age, preoperative pupil size, medical and ocular conditions, incidence of IFIS and other intraoperative complications were recorded. The surgeons used the same preoperative procedures for all patients. Preoperative pupil dilation was classified as good (≥7mm), fair (6-5mm) or poor (<5mm).
Differences in the prevalence of diabetes, hypertension, glaucoma or pseudoexfoliation syndrome were not statistically different between groups. The mean age of patients was comparable for the control and Tamsulosin groups (73.4+7.6 and 75.6+6.9 years, respectively). The incidence of IFIS was higher in the Tamsulosin group (16 of 39) compared to the control group (10 of 194). These findings were statistically significant (p<0.0001). In the Tamsulosin group, iris prolapse was more frequent (p=0.001) and surgeons used different pupil management techniques more often (p=0.006). However, incidence of capsular tear was very low and was not different between groups. No apparent relationship between the preoperative dilation and the occurrence of miosis during cataract surgery were noted for either group of patients.
Our data showed a higher incidence of IFIS and iris prolapse in patients using Tamsulosin compared to controls. Our data highlights the fact that patients using Tamsulosin require special attention during cataract surgery. The use of specific techniques is crucial to avoid intraoperative complications.
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