Alpha antagonists and intraoperative floppy iris syndrome: A spectrum

Figures & data

Figure 1 Alpha-blockers and intraoperative floppy iris syndrome surgeon questionnaire.

Table 1 Alpha blocker treatment, indication, dosage, affinity to alpha receptor subtypes and gender

Medication	Number of patients (Number of eyes)	Male	Female	Indication for treatment	Daily dose	Relative affinity to α-receptor subtype
Doxazosin	15(18)	3	12	HTN	4–8 mg	α1A=α1B=α1D
Tamsulosin	9 (13)	9	0	BPH	0.4 mg	α1A=α1D>α1B
Indoramin	2 (4)	1	1	HTN	100 mg	α1A=α1B= α1D
Prazosin	2 (2)	2	0	HTN	5–10 mg	α1A=α1B=α1D
Alfuzosin	1 (1)	1	0	BPH	7.5 mg	α1A=α1B=α1D
Combination (Tamsulosin+ Doxazosin)	2 (2)	2	0	HTN + BPH	As above
Total	31 (40)	18	13

Abbreviations: BPH, benign prostatic hyperplasia; HTN, hypertension.

Table 2 Mean pupil diameter (in millimeters) before and after dilation with cyclopentolate 1% and phenylephrine 2.5%

	Predilation Right eye	Predilation Left eye	Postdilation Right eye	Postdilation Left eye
Tamsulosin group	3.6 (±1.3)	3.5 (±1.3)	7.8 (±1.1)	7.3 (±0.9)
Nontamsulosin group	3.5 (±0.6)	3.6 (±0.6)	7.1 (±0.9)	7.2 (±1.5)
P-value	0.655	0.915	0.095	0.692

Figure 2 Incidence of intraoperative floppy iris syndrome (IFIS) with different alpha antagonists.

Table 3 Patients who had features of intraoperative floppy iris syndrome

Age	Sex	Alpha-antagonist	DM	Iris flaccid	Iris prolapse	Intraoperative miosis	Intraoperative intervention
83	M	Doxazosin	N	Y	Y	Y	Nil
90	F	Indoramin	N	Y	N	Intraoperative intervention used	Iris Hooks
82	M	Prazosin	Y	Y	N	N	Nil
87	M	Prazosin	N	Y	N	Intraoperative intervention used	Intracameral Phenylphrine
73	M	Tamsulosin	N	Y	N	Intraoperative intervention used	Iris Hooks
75	M	Tamsulosin	N	Y	N	Intraoperative intervention used	Iris Hooks
88	M	Tamsulosin	N	N	Y	Intraoperative intervention used	Iris Hooks
74	M	Tamsulosin	N	Y	N	Intraoperative intervention used	Iris Hooks
87	M	Tamsulosin	N	Y	Y	N	Nil
73	M	Tamsulosin	N	N	Y	N	Nil
73	M	Tamsulosin	N	N	Y	N	Nil
77	M	Tamsulosin	N	Y	N	Intraoperative intervention used	Iris Hooks
85	M	Tamsulosin	N	Y	Y	Intraoperative intervention used	Intracameral Phenylphrine
70	M	Tamsulosin+ doxazosin	Y	Y	Y	Y	Nil

Abbreviations: DM, Diabetes Mellitus; Y, yes; N, no.

Table 4 Occurrence of intraoperative floppy iris syndrome (IFIS) in patients who had bilateral cataract surgery.

Medications	Bilateral IFIS	Unilateral IFIS	No signs of IFIS	Total number of patients
Tamsulosin	1	2	1	4
Doxazosin	0	1	2	3
Indoramin	0	1	1	2
Total	1	4	4	9