Floppy Iris Syndrome: Why BPH Treatment Can Complicate Cataract Surgery

摘要

Another unexpected and remarkable finding is that IFIS can occur more than one year after tamsulosin has been discontinued.1,2 Ninety-five percent of ASCRS survey respondents have experienced IFIS in patients with only a previous history of alpha-1 antagonist use.8 Histopathologic analysis of autopsy eyes from patients who were taking tamsulosin shows atrophy of the iris dilator muscle, which would be consistent with a semipermanent drug effect.9 Because stopping alpha blockers pre-operatively is of questionable benefit, only 11 percent of survey respondents routinely discontinue tamsulosin before cataract surgery.8 Ophthalmologists can now anticipate IFIS by eliciting a history of past or current systemic alpha-blocker use, and a number of alternative surgical strategies can be used to improve outcomes for these patients.1,2 However, ophthalmologists remain wary of the surgical complications associated with IFIS, such as iris damage, torn lens capsules, and vitreous prolapse.8 Ninety-five percent of the ASCRS survey respondents believe that tamsulosin still increases the difficulty of cataract surgery, and 77 percent believe that it increases the risks.8 Nearly two thirds of respondents would avoid tamsulosin if they themselves had a mildly symptomatic cataract.8 This group would take a nonselective alpha-1 antagonist, avoid alpha-1 antagonists altogether, or have their mildly symptomatic cataract removed first.