Doxazosin-related intraoperative floppy iris syndrome (IFIS): a prospective, interventional, comparative study

Session Details

Session Title: Cataract Surgery Complications Management. OVDs, Cataract Surgery Equipment

Session Date/Time: Monday 07/09/2015 | 08:00-10:00

Paper Time: 08:00

Venue: Main Auditorium

First Author: : R.Deshmukh UK

Co Author(s): :    G. Carifi   M. Minihan   V. Zygoura   V. Maurino           

Abstract Details

Purpose:

To evaluate the incidence of Intraoperative floppy iris syndrome (IFIS) during phacoemulsification cataract surgery among patients using doxazosin, to compare IFIS incidence and severity, and associated intraoperative complications between patients on doxazosin and tamsulosin, and to observe the prevalence of patients treated with these alpha-1 adrenergic antagonists undergoing cataract surgery at our Institution.

Setting:

Moorfields Eye Hospital, London, UK.

Methods:

A high-volume same-surgeon consecutive case-series of eyes undergoing cataract surgery in a 2-year period (Nov 2012-Nov 2014) was used to assess the prevalence of patients on the 2 alpha-1 adrenergic antagonists. For the identified patients on doxazosin and tamsulosin, data collection included preoperative maximum pupillary dilatation (<4mm (small pupil), 4-6mm (moderate pupil), and >6mm (large pupil)), intraoperative grading of IFIS (progressive intraoperative miosis, iris billowing, and iris prolapse), and associated intraocular complications (capsule complications with or without vitreous loss, iris trauma, and others).

Results:

84 eyes of 79 patients were studied. Prevalence of doxazosin and tamsulosin use was 2.4% and 3%, respectively, among the 1558 eyes (1482 patients) screened. In the doxazosin group (37 eyes), preoperative small or moderate pupil size was observed in 14% and 16% of eyes, respectively; 41% displayed incomplete IFIS, while 11% had severe form of complete IFIS. Intraoperative complication was 11%, where 3 eyes suffered with iris trauma and one had zonular dialysis. In the tamsulosin group (47eyes), 21% had small and 38% moderate pupil size preoperatively; incomplete IFIS was seen in 85% and complete IFIS in 11% cases. Intraoperative complications were 9% with 2 eyes having iris trauma, one zonular dialysis and one suffered with anterior capsular tear.

Conclusions:

Patients on doxazosin were less likely to display signs of IFIS comparing to patients on tamsulosin (P>0.0001) in this study. Similar rates of severe IFIS and associated intraoperative complications were observed in eyes of patients taking these two alpha-1 adrenergic antagonists. Therefore, we would recommend that patients on doxazosin undergoing cataract surgery should be considered at risk of IFIS (like patients on tamsulosin) and should be operated by experienced surgeon to minimize unfavorable outcomes.

Financial Interest:

NONE