Incidence And Surgical Management Of Intraoperative Iris Floppy Syndrome In Tamsulosin, Alfuzosin And Silodosin Users : A Comparitive Study
Published 2025 - 43rd Congress of the ESCRS
Reference: PP11.02 | Type: Free paper | DOI: 10.82333/980t-bs97
Authors: Madalina Pavel* 1 , Ujjwal Banerjee 2 , Mo Abu-Bakra 3 , Obeda Kailani 3 , Gerassimos Lascaratos 3 , Sameer Trikha 1 , Avi Kulkarni 1
1Ophthalmology,King's College Hospital NHS Foundation Trust,London,United Kingdom, 2The Jones Faculty,Wellcome Sanger Institute,Cambridge,United Kingdom, 3Ophthalmology,King's College Hospital NHS Foundation Trust,London,United Kingdom;School of Life Sciences, Ophthalmology,King’s College London,London,United Kingdom
Purpose
The goal of this study is to evaluate and compare the incidence of Intraoperative Floppy Iris syndrome (IFIS) in men taking Tamsulosin,Alfuzosin and Silodosin and to assess the surgical outcomes resulting from its management.
Setting
Khairabad Eye Hospital And Mahendra Eye Hospital,Kanpur,India
Methods
We performed cataract surgeries on 120 eyes of 96 patients treated with alpha-1 adrenergic receptor antagonists for benign prostatic hyperplasia (BPH). Patients were divided into three groups: Group A (Tamsulosin), Group B (Alfuzosin), and Group C (Silodosin). A comprehensive ocular assessment was done for each patient. The pre-operative regimen included topical nepafenac (0.1%) two hours before surgery, followed by pupillary dilation with tropicamide (1%) and phenylephrine (5%). Phacoemulsification was performed using the direct phacochop technique through a 2.4 mm clear corneal incision. Intraoperative floppy iris syndrome (IFIS) was noted.
Results
Among the 72 patients using Tamsulosin, 32 (44%) experienced IFIS. In the group of 30 patients taking Alfuzosin, 6 (20%) developed IFIS, while only 2 out of 18 patients using Silodosin experienced IFIS. Intraoperative complications were infrequent, with minor issues such as iris chafing, localized iris stromal atrophy, iris trauma, iris incarceration at the wound site, and cystoid macular edema. There were no instances of posterior capsular rupture or vitreous loss. The highest rate of complications was observed in patients on Tamsulosin.
Conclusions
Patients using Tamsulosin were found to have a notably higher likelihood of developing Intraoperative Floppy Iris Syndrome (IFIS) compared to those using Alfuzosin or Silodosin. To mitigate this risk, several precautionary techniques were implemented, including gentle hydrodissection, intracameral administration of phenylephrine, reduced phacoemulsification parameters, the use of suitable ocular viscoelastic devices (OVD), and the insertion of a Malyugin ring in cases of intraoperative miosis. Among the three medications, Silodosin was identified as the safest option with the least risk of Intraoperative Floppy Iris syndrome (IFIS) complications.