Correlation between urological alpha1-AR antagonist medication and changed intraoperative iris behavior

The aim of our study was to report on the incidence, the etiology and the management of intraoperative floppy iris syndrome (IFIS) during phacoemulsification. A non-randomized, observational, prospective study was performed for 1 year, in which 439 eyes of 438 patients (320 men and 118 women) undergoing cataract surgery by the same surgeon were enrolled. The surgeon was blinded to the patients’ drug history. The use or non-use of alpha blockers (especially tamsulosin for benign prostatic hyperplasia), duration of the treatment, presence or absence of IFIS, management of IFIS and intraoperative complications were recorded. A 3.2 mm incision was performed on 316 eyes and a 2.4 mm incision on 123 eyes. IFIS occurred in 2.96% of the patients who were taking an alpha1 antagonist. In 5.47% we identified an intraoperative iris behaviour which imitated an incipient IFIS stage called IFI-like syndrome. In cases of insufficiently dilated pupils, diluted intracameral epinephrine as well as irrigation fluid was used. Vertical chop, stability of the anterior chamber by decreasing the corneal wound size, and reducing turbulence into the anterior chamber, enhanced the surgery on eyes with IFIS. There were no intraoperative or postoperative complications. The incidence of IFIS in our study was linked to alpha blocker medication. We postulate that IFIS may be caused by other medication, but this could not be demonstrated statistically. IFIS can be well controlled during surgery, intracameral epinephrine being the main stabilizing factor.