What is intraoperative floppy iris syndrome?

The intra-operative floppy iris syndrome (IFIS) is a variant of the small pupil syndrome. It has been observed during cataract surgery in some patients currently or previously treated with the αl adrenoceptor (AR) antagonist



Conclusion: Clinical response to a 12-week tamsulosin treatment improved during the course of treatment, reflected in a reduction in all of the lower urinary tract symptoms, with rare and insignificant side effects.


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Efficacy and safety of tamsulosin in the treatment of benign prostatic …


What is intra operative floppy iris syndrome?

Sir, Intraoperative floppy iris syndrome (IFIS) is a recently described phenomenon affecting cataract surgery. It consists of poor preoperative pupil dilation together with progressive intraoperative pupil constriction, billowing of a flaccid iris stroma, and iris prolapse to the surgical incisions.

What causes floppy iris syndrome?

Intraoperative floppy iris syndrome (IFIS) was first characterized by Chang and Campbell in 2005. It is associated with the use of systemic α-receptor blockers, such as tamsulosin (Flomax), used in the medical management of benign prostatic hyperplasia (BPH).

Does Floppy Iris affect vision?

The iris can also slip out of its normal position during surgery, making it even harder for the ophthalmologist to remove the old lens and insert a new one. This condition, dubbed floppy iris syndrome, increases the chance of complications, including vision loss.

How do you treat floppy iris?

Intraoperative Floppy Iris Syndrome Treatment

These include expansion rings and iris hooks/retractors. If used correctly, iris hooks offer a mechanical method for reversing miosis. Further, hooks and retractors can help prevent iris prolapse during surgery.

Which medication can cause intraoperative floppy iris syndrome in cataract surgery patients?

The uroselective alpha-blocker tamsulosin is the most commonly used drug among all. Studies showed that the majority of the patients who develop intraoperative floppy iris syndrome (IFIS) were on tamsulosin.

How can intraoperative floppy iris be prevented?

IFIS can be prevented and treated by maintaining mydriasis and restraining the iris from prolapsing during cataract surgery. This can be accomplished by mechanical and pharmacologic treatments and the use of intraoperative proper phacoemulsification fluidic parameters.

Can a floppy iris be repaired?

The permanently dilated pupil can be elegantly repaired with a suture cerclage technique unless iris atrophy is extensive, frequently the case with long-standing dilation.

What medications should be stopped before cataract surgery?

1. MEDICATIONS To minimize the risk of blood loss during your surgery, you must avoid or stop taking medications that contain aspirin, that are anti-inflammatory medications, or contain blood thinning agents. These should be discontinued 7-10 days prior to your surgery.

Does saw palmetto cause floppy iris syndrome?

Intraoperative floppy-iris syndrome (IFIS) has been associated with multiple α 1-adrenergic antagonist systemic medications, including tamsulosin (Flomax), doxazosine (Cardura), terazaosin (Hytrin), and alfuzosin (Uroxatra).

How can we avoid IFIS?

To prevent IFIS and its signs, Samuel Masket described pre-medicating at-risk patients with topical atropine sulfate 1% three times a day for two days before surgery, standard mydriatics and intraoperative intracameral epinephrine, attributing success in 19/20 eyes to synergy between the pupillary block provided by …

Should tamsulosin be stopped before surgery?

The doctor may advise you to stop taking tamsulosin 2 weeks before surgery. This is because tamsulosin may cause complications during the cataract or glaucoma operation. For any other surgery, ask the nurse or doctor at your pre-assessment appointment if you need to stop taking tamsulosin.

Does tamsulosin cause floppy iris syndrome?

Intraoperative floppy iris syndrome has most commonly been associated with tamsulosin, a selective alpha1 adrenergic antagonist used for relief of lower urinary tract symptoms associated with benign prostatic hypertrophy. The syndrome is nine times more prevalent in males.

Does silodosin cause IFIS?

Silodosin, a new selective alpha 1 antagonist, has similar kinetics to tamsulosin in rabbit iris and was associated with IFIS in two recent case reports [6, 7, 11]. Ipekci et al. [6] first reported silodosin-associated IFIS in a 60-year-old man.

What is the side effect of tamsulosin?

you should know that tamsulosin may cause dizziness, lightheadedness, a spinning sensation, and fainting, especially when you get up too quickly from a lying position. This is more common when you first start taking tamsulosin or after your dose is increased.

Can I take tamsulosin after cataract surgery?

Can I still have cataract surgery if I take Flomax? Yes. If ophthalmologists know that a patient is taking an alpha-blocker or used to take one, they can modify the surgical techniques used during cataract surgery to reduce — but not completely eliminate — the risk of complications.

Can I take aspirin before cataract?

NOTE: PATIENTS SCHEDULED FOR CATARACT SURGERY combined with GLAUCOMA SURGERY Patients who will be having glaucoma surgery please stop aspirin 10 days ahead of time.

Is Flomax by prescription only?

Flomax is a prescription medicine used to treat the symptoms of benign prostatic hyperplasia (enlarged prostate), bladder outlet obstruction and kidney stones. Flomax may be used alone or with other medications. Flomax belongs to a class of drugs called Alpha 1 Blockers.

Can tamsulosin cause blurred vision?

The US SmPC of tamsulosin mentions the following: “In a pooled analysis from 2 multicenter, double-blind, placebo-controlled, 13-week studies in men with benign prostatic hyperplasia, blurred vision occurred in 0.2% and 2% of patients who received tamsulosin 0.4 mg/day (n=502) and 0.8 mg/day (n=492), respectively, …

How do they fix cataracts?

During cataract surgery, the clouded lens is removed, and a clear artificial lens is usually implanted. In some cases, however, a cataract may be removed without implanting an artificial lens. Surgical methods used to remove cataracts include: Using an ultrasound probe to break up the lens for removal.

Is alfuzosin an alpha blocker?

Alfuzosin is in a class of medications called alpha blockers. It works by relaxing the muscles in the prostate and bladder to allow urine to flow more easily.

What happens when your iris collapses?

When small tears occur on the very edge of the iris, they can “lead to scarring on that area that subsequently blocks the drain of the eye, leading to higher eye pressure and glaucoma.”

Does cataract surgery affect the iris?

Cataract surgery has no effect on iris pattern recognition, whereas pupil dilation may be used to defeat an iris-based authentication system.

How do you break an iris eye?

Iridodialysis (arrow), separation of the iris from the attachment at the ciliary body, can occur with blunt trauma to the eye (eg, air bag deployment). Management is usually with bed rest and observation, surgical repair may be considered for severe cases.

Why can’t you drink water before cataract surgery?

Before any surgery, you should try to increase your water intake. The human body is made up of up to 60% water! Though you are not put to sleep during cataract surgery, it can still be quite taxing on your body. Water is one of the best things you can put into your body, especially while it’s healing.

How many days rest is needed after cataract surgery?

Most people are able to return to work or their normal routine in 1 to 3 days. After your eye heals, you may still need to wear glasses, especially for reading. This care sheet gives you a general idea about how long it will take for you to recover.

Do you have to go off blood thinners for cataract surgery?

Blood thinners do not have to be stopped before cataract surgery. Because we are not working on tissues that contain blood vessels, bleeding is usually not a major concern. Patients taking Coumadin, Warfarin, Plavix, Eliquis, Pradaxa, Ibuprofen or Aspirin do NOT generally have to stop these medications.

Can tamsulosin cause cataracts?

Context Both benign prostatic hyperplasia (BPH) and cataract formation are common in older men. The α-adrenergic receptor blocker tamsulosin is frequently prescribed to treat BPH, and research suggests this drug may increase the intraoperative difficulty of cataract surgery.

Does finasteride affect pupil dilation?

Drugs that interfere with the pupil’s enlargement muscle in the iris can cause serious surgical complications if the eye surgeon is unaware that their patient is taking or, just as important, has ever taken Tamsulosin (Flomax or Jalyn), Dutasteride (Avodart), Finasteride (Proscar), Alfuzosin (Uroxatral), Silodosin ( …

Can finasteride cause cataracts?

In these cases, finasteride was suspected to be the cause of the anterior subcapsular cataracts and IFIS. Therefore, finasteride can be associated with cataracts and IFIS, and it should be stopped before cataract surgery [27, 28, 29].

Does silodosin cause floppy iris syndrome?

Silodosin, however, is pharmacologically similar to tamsulosin (Flomax, Boehringer Ingelheim Pharmaceuticals), which is associated with intraoperative floppy iris syndrome (IFIS), a complication that can occur during cataract surgery.

What drugs should not be taken with tamsulosin?

Examples of drugs that can cause interactions with tamsulosin are listed below.

  • Acid-blocking drug. Taking cimetidine with tamsulosin can increase the levels of tamsulosin in your body. …
  • Antibiotic. …
  • Antidepressant (SSRI) …
  • Antifungal drugs. …
  • Erectile dysfunction (ED) drugs. …
  • Other benign prostatic hyperplasia drug. …
  • Alpha blockers.

Can tamsulosin affect bowel movements?

The lower incidence of diarrhea with tamsulosin as compared with a nonselective subtype α1 blocker (prazosin) may be due to lack of its effect on intestinal smooth muscle. Moreover, the tone of the internal anal sphincter reduces with age that may also contribute to diarrhea.

Does tamsulosin make you pee more?

Tamsulosin helps relax the muscles in the prostate gland and the opening of the bladder. This may help increase the flow of urine or decrease symptoms.

Does Flomax affect eye pressure?

Tamsulosin and other alpha-blockers may impede pupil dilation and cause the “IFIS triad” (a flaccid and billowing iris, iris prolapse through the surgical incisions and progressive intraoperative pupil constriction). This triad can potentially result in complications, such as iris trauma and posterior capsule rupture.

What drugs are 5 alpha reductase inhibitors?

Drugs in the 5-ARI class are finasteride and dutasteride. These drugs are marketed under the brand-names Proscar, Propecia, Avodart, and Jalyn. Finasteride is available in two different strengths: Proscar 5 mg tablets and Propecia 1 mg tablets.

Which is better silodosin or tamsulosin?

Both treatments were well-tolerated. Retrograde ejaculation was encountered only with silodosin and postural hypotension only with tamsulosin. Conclusions: Silodosin is comparable to tamsulosin in the treatment of BPH in Indian men. However, retrograde ejaculation may be troublesome for sexually active patients.

What happens if you stop taking silodosin?

Silodosin is used for long-term treatment. It comes with serious risks if you don’t take it as prescribed. If you don’t take it at all or stop taking it: If you don’t take or stop taking this drug, you may have increased symptoms of BPH.

Can I stop taking silodosin?

Do not take more or less of it or take it more often than prescribed by your doctor. Silodosin controls the symptoms of BPH but does not cure it. Continue to take silodosin even if you feel well. Do not stop taking silodosin without talking to your doctor.