Department of Ophthalmology, University of California, San Francisco, San Francisco, California, and private practice, Los Altos, California.
Private practice, Marin, California.
Ophthalmology. 2014 Apr;121(4):829-34. doi: 10.1016/j.ophtha.2013.10.031. Epub 2013 Dec 4.
To determine whether severe intraoperative floppy iris syndrome (IFIS) is more or equally likely with tamsulosin or alfuzosin.
Prospective, masked, multicenter, cross-sectional study.
Consecutive patients taking systemic tamsulosin or alfuzosin and scheduled for routine cataract surgery (case group) and patients with no history of systemic α1-antagonists scheduled for routine cataract surgery (control group).
Phacoemulsification with intraocular lens implantation was performed and recorded on video. Intracameral phenylephrine or epinephrine, either by direct injection or placement in the irrigation bottle, was not permitted. Every surgical video subsequently was reviewed remotely by 2 masked investigators who diagnosed the presence or absence of IFIS and graded the severity of IFIS as follows: none, mild (billowing only), moderate (billowing and either iris prolapse or ≥2 mm of pupil constriction), or severe (billowing accompanied by iris prolapse and ≥2 mm of pupil constriction).
Rate and severity of IFIS and surgical complication rate.
A total of 226 eyes (70 in the tamsulosin group, 43 in the alfuzosin group, and 113 in the control group) were enrolled. Severe IFIS was noted in 34.3% (24/70) of the tamsulosin eyes and in 16.3% (7/43) of the alfuzosin eyes compared with 4.4% (5/113) of the control eyes. The differences between each of the 3 groups were statistically significant. In the absence of epinephrine in the irrigation bottle, 12.4% of control eyes had moderate to severe IFIS. There were no instances of posterior capsular rupture or significant surgical complications in either the case or control groups.
Moderate to severe IFIS can occur in low-risk eyes when epinephrine is omitted from the irrigation bottle. Although both tamsulosin and alfuzosin significantly increase the risk of IFIS compared with patients without prior α1-antagonist intake, severe IFIS statistically was more likely with tamsulosin than with alfuzosin (P = 0.036). Patients with symptomatic benign prostatic hyperplasia and cataracts requiring a uroselective α1-antagonist may consider trying alfuzosin first.
确定坦索罗辛或阿夫唑嗪是否更易或同等程度地导致术中严重虹膜膨隆综合征（IFIS）。
前瞻性、盲法、多中心、横断面研究。
连续服用全身坦索罗辛或阿夫唑嗪并计划行常规白内障手术的患者（病例组）和无全身α1-拮抗剂史、计划行常规白内障手术的患者（对照组）。
进行超声乳化白内障吸除术，并将手术过程录像。不允许直接注射或将苯肾上腺素或肾上腺素放入灌洗瓶内进行眼内注射。然后由 2 名盲法调查员远程观看所有手术录像，他们诊断 IFIS 的存在或不存在，并将 IFIS 的严重程度分级如下：无、轻度（仅膨隆）、中度（膨隆且虹膜脱垂或瞳孔收缩≥2mm）或重度（膨隆伴虹膜脱垂和瞳孔收缩≥2mm）。
IFIS 的发生率和严重程度以及手术并发症发生率。
共纳入 226 只眼（坦索罗辛组 70 只眼、阿夫唑嗪组 43 只眼、对照组 113 只眼）。坦索罗辛组 34.3%（24/70）的眼和阿夫唑嗪组 16.3%（7/43）的眼出现严重 IFIS，而对照组中仅 4.4%（5/113）的眼出现严重 IFIS。每组之间的差异均具有统计学意义。在灌洗瓶中不含肾上腺素的情况下，对照组中 12.4%的眼出现中重度 IFIS。在病例组和对照组中均未发生后囊破裂或显著手术并发症。
当灌洗瓶中不含肾上腺素时，低危眼也可能发生中重度 IFIS。与无先前α1-拮抗剂摄入的患者相比，坦索罗辛和阿夫唑嗪均显著增加 IFIS 的风险，但与阿夫唑嗪相比，坦索罗辛发生重度 IFIS 的统计学可能性更大（P=0.036）。有症状的良性前列腺增生且需要使用尿选择性α1-拮抗剂的患者可能会考虑首先尝试使用阿夫唑嗪。
