Intraoperative floppy iris syndrome

Intraoperative floppy iris syndrome (IFIS) is a complication that may occur during cataract extraction in certain patients. This syndrome is characterized by a flaccid iris which billows in response to ordinary intraocular fluid currents, a propensity for this floppy iris to prolapse towards the area of cataract extraction during surgery, and progressive intraoperative pupil constriction despite standard procedures to prevent this. [Chang DF, Campbell JR. "Intraoperative floppy iris syndrome associated with tamsulosin." "J Cataract Refract Surg." 2005 Apr;31(4):664-73. PMID 15899440.]

IFIS has been associated with Flomax (tamsulosin), a medication widely prescribed for urinary symptoms associated with benign prostatic hyperplasia. This medication Tamsulosin is a selective alpha blocker that works by relaxing the bladder and prostatic smooth muscle. As such, it also relaxes the iris dilator muscle by binding to its postsynaptic nerve endings. [Schwinn DA, Afshari NA. "alpha(1)-Adrenergic receptor antagonists and the iris: new mechanistic insights into floppy iris syndrome." "Surv Ophthalmol." 2006 Sep-Oct;51(5):501-12. PMID 16950249.] [Parssinen O, Leppanen E, Keski-Rahkonen P, Mauriala T, Dugue B, Lehtonen M. "Influence of tamsulosin on the iris and its implications for cataract surgery." "Invest Ophthalmol Vis Sci." 2006 Sep;47(9):3766-71. PMID 16936084.]

IFIS may also be associated with other causes of small pupil like synechiae, pseudoexfoliation and other medications (used for conditions such as glaucoma, diabetes and high blood pressure). IFIS does not usually cause significant changes in postoperative outcomes. Patients may experience more pain, a longer recovery period, and less improvement in visual acuity than a patient with an uncomplicated cataract removal.

The severity of the condition is not linked to the duration of tamsulosin intake. [Cheung CM, Awan MA, Sandramouli S. "Prevalence and clinical findings of tamsulosin-associated intraoperative floppy-iris syndrome." "J Cataract Refract Surg." 2006 Aug;32(8):1336-9. PMID 16863971.]

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