Intraoperative floppy iris syndrome

To describe the condition known as intraoperative floppy iris syndrome in association with systemic alpha-1 blocker use in patients undergoing cataract surgery and techniques to prevent related complications.

In recent years, an unexpected complication of progressive intraoperative miosis, iris billowing, and prolapse was noted during routine phacoemulsification in patients with current or previous use of alpha-1 adrenergic receptor antagonists. The syndrome is particularly prevalent among patients treated with tamsulosin, an alpha-1A blocker prescribed for the treatment of benign prostatic hyperplasia. This condition is also seen, in smaller numbers, in patients treated with nonspecific alpha-1 blockers. Intraoperative floppy iris syndrome was noted to occur even when patients discontinued alpha-1 blocker medication for years prior to cataract surgery. Several surgical techniques have been successfully employed to circumvent adverse outcomes in patients with known alpha-1 blocker use. However, the risk remains in patients who do not disclose current or prior use of these medications.

There are several clinical concerns, such as most effective methods of managing intraoperative floppy iris syndrome, increasing awareness among physicians and patients about potential risk associated with this class of drug, and importance of disclosure of use prior to cataract surgery.