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Alpha-Blocker Increases Risk of Intraoperative Floppy Iris Syndrome

A specific alpha-blocker can complicate and increase the risk of intraoperative floppy iris syndrome (IFIS) during cataract surgery, according to results of a survey conducted by the American Society of Cataract and Refractive Surgery (ASCRS) members.

"[The survey] kind of confirmed what we were … hearing anecdotally, which is that a lot of doctors feel that patients should not be started on an alpha-blocker until they see an ophthalmologist," said David F. Chang, M.D., chair of the ASCRS Cataract Clinical Committee.

Ninety percent of survey respondents said that in their experience, IFIS was more likely to occur with Flomax (tamsulosin, Boehringer Ingelheim) than with other nonspecific alpha-1 antagonists.

A total of 95% of respondents with adequate experience with IFIS reported encountering the syndrome in patients with a history of alpha-1 antagonist use; two-thirds of respondents said they routinely question patients about past use of alpha-1 antagonists.

In addition, 95% of respondents said that cataract surgery was more difficult in tamsulosin patients, and 77% said they believed there was increased surgical risk in tamsulosin patients compared with patients who were not taking the drug.

"If 95% of people say that it makes surgery more difficult, it's a big issue," Dr. Chang said.

Another concern voiced by Dr. Chang is that ophthalmologists cannot rely on patients to accurately report their medication use. Most respondents said that less than one-third of patients taking alpha-blockers reported their use of such drugs to their cataract surgeon.

Because of the risk associated with tamsulosin use, 59% of respondents suggested that patients with a history of cataract or decreased vision should consult their ophthalmologist before using the drug.

A majority of respondents said that it is necessary to better educate prescribing physicians about the increased risk of IFIS in patients using alpha-1 antagonists.

Commonly reported complications of IFIS were significant iris trauma and posterior capsule rupture, with 52% and 23% of respondents, respectively, reporting these complications at a higher rate than in non-IFIS eyes. There was no single preferred surgical method for managing IFIS; 33% of respondents routinely used multiple strategies.

Of respondents with sufficient experience:

► 90% believe that IFIS is more likely with tamsulosin than with non-specific SYMBOL1-antagonists

► 91% believe that physicians prescribing SYMBOL1-antagonists should become better educated about IFIS

► 59% would recommend a pretreatment ophthalmic evaluation for patients with cataracts or decreased vision

► If they themselves had mildly symptomatic cataracts, 64% of respondents would avoid taking tamsulosin or would have their cataract removed first. OM

About These Data: A 26-question online survey was administered to 6,000 ASCRS members concerning their clinical experience with IFIS. A total of 957 members completed the survey; 75% of respondents were from the United States. The survey results were published in the July issue of Journal of Cataract and Refractive Surgery.