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Tamsulosin vs alfuzosin: comparative incidence and severity of intraoperative floppy iris syndrome (ifis)

Session Details

Session Title: Complex Cases and Surgery

Session Date/Time: Monday 07/10/2013 | 14:30-16:00

Paper Time: 14:33

Venue: Forum (Ground Floor)

First Author: : C.Schweitzer FRANCE

Co Author(s): :    J. Campbell   J. Febbraro   T. Amzallag   P. Rozot   J. Colin   D.

Abstract Details

Purpose:

To determine whether IFIS is less severe or frequent with one of these agents would have important implications for patients being started on systemic alpha blockers for BPH (benign prostatic hyperplasia)

Setting:

university hospital pellegrin, Bordeaux, France/ Los Altos, California, USA

Methods:

a prospective comparative multicenter study was performed during a two year period beginning in January 2009. All patients undergoing cataract surgery who were taking either tamsulosin or alfuzosin were enrolled (case groups 1 and 2 respectively). For each alpha blocker patient, a control patient was selected on the same operative day by the same surgeon (group 3). All cataract surgeries were video recorded and analyzed by two experienced surgeons masked to patient groupings. Incidence of the IFIS, IFIS grade, preoperative and postoperative pupil size and the occurrence of surgical complications were compared between groups

Results:

226 eyes (n=214 patients) were enrolled (Group 1: Tamsulosin (n=70), Group 2: Alfuzosin (n=43), Group 3: controls (n=113)). The incidence of IFIS was 63.7% (n=73) in the case groups and 24.8% (n=28) in the control group (p<0.001). IFIS severity was significantly different between control and case groups (Grade 1: n=14/n=16; Grade 2: n=9/n=25; Grade 3: n=5/n=31 respectively) (p<0.001). The incidence of IFIS was not significantly different between group 1 and 2 (60% (n=42) and 69.8% (n=30) respectively, but 34.3% (n=24) tamsulosin eyes had a grade 3 of IFIS compared to 16.3% (n=7) alfusozin eyes (p<0.001). There was no severe intraoperative complication in case and control groups

Conclusions:

Alfuzosin is an uroselective systemic alpha-blocker that, unlike tamsulosin, is not selective for the alpha-1A receptor. The risk of IFIS is not the same with all systemic alpha-blockers, it should be a consideration for patients who are likely to need cataract surgery

Financial Interest:

NONE