Intraoperatives Floppy Iris Syndrom (IFIS) bei Tamsulosineinnahme

Zusammenfassung

Hintergrund Tamsulosin ist eines der am häufigsten verschriebenen alpha-1A-Antagonisten zur Behandlung des benignen Prostatasyndrom (BPS). Bei einer Kataraktoperation entwickeln diese Patienten häufig ein intraoperatives floppy Iris Syndrom (IFIS). Dabei kommt es zu einer zunehmenden Miosis und einer undulierenden Iris, welches das Komplikationsrisiko deutlich erhöht und bleibende Schäden verursachen kann.

Ziel der Arbeit Ziel ist es Bewusstsein für die Folgen einer Tamsulosineinnahme bei Kataraktoperationen zu schaffen.

Material und Methoden Wir führten eine Review der veröffentlichten Publikationen über die Assoziation von IFIS bei Kataraktoperation mit Alpharezeptorblockern durch.

Ergebnisse und Diskussion Tamsulosin hat ein bis zu 80 %-iges Risiko für Komplikationen, wohingegen Doxazosin und Alfuzosin lediglich eine Komplikationswahrscheinlichkeit von 15–20 % haben. Tamsulosin stellt somit einen erheblichen Risikofaktor für permanente Folgeschäden nach Kataraktoperation dar. Auch nach Absetzen von Tamsulosin wurden noch nach bis zu 3 Jahren IFIS beobachtet, ein pausieren vor Katarakoperation wird dennoch empfohlen. Ein Alternativpräparat sollte somit bei Patienten, die noch keine Kataraktoperation erhalten haben, bevorzugt werden. Sind die Patienten bereits kataraktoperiert, kann Tamsulosin ohne Bedenken gegeben werden.

Abstract

Background Tamsulosin is one of the most commonly prescribed alpha-1A antagonists for the treatment of benign prostatic syndrome (BPS). Patients treated with tamsulosin often develop intraoperative floppy iris syndrome (IFIS) during cataract surgery. This leads to increasing miosis and an undulating iris, which increases the risk of complications significantly and can cause permanent damage.

Aim of the work The aim is to raise awareness for the effects of tamsulosin intake before cataract surgery.

Material and methods We conducted a critical review of publications on the association of IFIS in cataract surgery with alpha-receptor blockers.

Results and discussion Tamsulosin has a risk of complications of up to 80 %, whereas doxazosin and alfuzosin only have a 15–20 % chance of complications. Tamsulosin therefore represents a significant risk factor for permanent secondary damage after cataract surgery. Even after discontinuing tamsulosin, IFIS was still observed after up to 3 years. Nevertheless, pausing of tamsulosin intake is recommended. An alternative preparation should therefore be preferred in patients who have not yet had cataract surgery. If patients are already pseudophakic, tamsulosin can be given without concern.

Schlüsselwörter

Tamsulosin - Floppy Iris Syndrom - benignes Prostatasyndrom (BPS) - Katarakt

Keywords

floppy iris syndrome - cataract - tamsulosin - benign prostatic syndrome - intraoperative floppy iris syndrome

Publikationsverlauf

Artikel online veröffentlicht:
10. März 2021

• Literatur

• 1 Arzneimittelkommission der deutschen Ärzteschaft. Intraoperatives Floppy-Iris-Syndrom im Zusammenhang mit Tamsulosin. Deustches Ärztebaltt 2020; 37: 1711-1712
• 2 ASCRS und AAO Leitlinien: Leitlinien der American Society of Cataract and Refractive Surgery (ASCRS) und American Academy for Opthalmology (AAO). 2014 Verfügbar unter (Abgerufen am 29 September 2020): https://www.aao.org/clinical-statement/intraoperative-floppy-iris-syndrome-ifis-associate-2
• 3 Bell MD, Wendy V, Hatch OD. et al. Association Between Tamsulosin and Serious Ophthalmic Adverse Events in Older Men Following Cataract Surgery. JAMA 2009; 301 (19) 1991-1996
• 4 Blouin MC, Blouin J, Perreault S. et al. Intraoperative floppy iris syndrom associated with alpha1-adrenoreceptors: comparism of Tamsulosin und Alfuzosin. J Catraract Refract Surg 2007; 33: 1227-34
• 5 Campbell RJ, El-Defrawy SR, Gill SS. et al. Evolution in the Risk of Cataract Surgical Complications among Patients Exposed to Tamsulosin: A Population-Based Study. Ophthalmology 04/2019; 126 (04) 490-496
• 6 Chang DF, Campbell JR. Intraoperative floppy iris syndrome associated with tamsulosin. J Cataract Refract Surg 2005; 31 (04) 664-73
• 7 Chang DF, Braga-Mele R, Mamalis N. et al. Clinical experience with intraoperative floppy-iris syndrome. Results of the 2008 ASCRS member survey. J Cataract Refract Surg 2008; 34 (07) 1201-9
• 8 Chang DF, Campbell JR, Colin J. et al. Prospective masked comparison of intraoperative floppy iris syndrome severity with tamsulosin versus alfuzosin. Ophthalmology 2014; 121: 829-834 . Epub 2013 Dec 4
• 9 Chatziralli IP, Theodoros N, Sergentanis T. Risk Factors for Intraoperative Floppy Iris Syndrome: A Meta-Analysis. Ophthalmology 04/2011; 118 (04) 730-5 . Epub 2010 Dec 18
• 10 Cheung CM, Awan MA, Sandramouli S. Prevalence and clinical findings of tamsulosin associated intraoperative floppy-iris syndrome. J Cataract Refract Surg 2006; 32: 1336-1339
• 11 Clement P, Bernabe J, Kia HK. et al. D2-like receptors mediate the expulsion phase of ejaculation elicited by 8-hydroxy-2-(di-N-propylamino) tetralin in rats. J Pharmacol Exp Ther 2006; 316: 830-834
• 12 European Association Of Urology. Management of Non-neurogenic Male LUTS [Online] Arnhem. The Netherlands: EAU Guidelines Office; 2019 Verfügbar unter (Abgerufen September 29 2020): https://uroweb.org/guideline/treatment-of-non-neurogenic-male-luts/5
• 13 Fanciullacci M, Sicuteri R, Alessandri M. et al. Buspirone, but not sumatriptan, induces miosis in humans: relevance for a serotoninergic pupil control. Clin Pharmacol Ther 1995; 57: 349-355
• 14 Flachbach AJ. Intraoperative floppy iris syndrom: Pathophysiology, prevention and treatment. Trans Am Ophthalmol Soc 2009; 107: 234-241
• 15 Gani J, Perlis N, Radomski S. Urogenic medications and ophthalmologic side effects: a review. Can Urol Assoc J 2012; 53-58
• 16 Giuliano F. Impact of medical treatments for benign prostatic hyperplasia on sexual function. BJU Int 2006; 97 (Suppl. 02) 34-38
• 17 Hieble JP, Bylund DB, Clarke DE. et al. International Union of Phar- macology. X. Recommendation for nomenclature of alpha 1-adrenoceptors: consensus update. Pharmacol Rev 1995; 47: 267-270
• 18 Kaczmarek IA, Prost ME, Wasyluk J. Clinical risk factors associated with intraoperative floppy iris syndrome: a prospective study. Int Ophthalmol 03/2019; 39 (03) 541-549
• 19 Lee YJ, Lee JW, Park J. et al. Nationwide incidence and treatment pattern of benign prostatic hyperplasia in Korea. Investig Clin Urol 2016; 57 (06) 424-430
• 20 Lokeshwar SD, Harper BT, Webb E. et al. Epidemiology and treatment modalities for the management of benign prostatic hyperplasia. Transl Androl Urol 2019; 8 (05) 529-539
• 21 Marklund-Bau H, Edéll-Gustafsson U, Spångberg A. Bothersome urinary symptoms and disease-specific quality of life in patients with benign prostatic obstruction. Scand J Urol Nephrol 2007; 41 (01) 32-41
• 22 Martin DJ, Angel I, Arbilla S. Functional uroselectivity. Eur Urol 1998; 33 (Suppl. 02) 12-18
• 23 Muramatsu I, Taniguchi T, Okada K. Tamsulosin: alpha1-adrenoceptor subtype-selectivity and comparison with terazosin. Jpn J Pharmacol 1998; 78: 331-335
• 24 Narayan P, Tunuguntla H. Long-Term Efficacy and Safety of Tamsulosin for Benign Prostatic Hyperplasia. Rev Urol 2005; 7 (Suppl. 04) S42-S48
• 25 Palea S, Chang DF, Rekik M. et al. Comparative effect of alfuzosin and tamsulosin on the contractile response of isolated rabbit prostatic and iris dilator smooth musceles: Possible model for intraoperative floppy iris syndrom. Cataract Refract Surg 2008; 34 (03) 489-96
• 26 Panagis L, Basile M, Friedman AH. et al. Intraoperative Floppy Iris Syndrome- Report of a Case and Histopathologic Analysis. Arch Ophthalmol 2010; 128 (11) 1437-1441
• 27 Pannar B, Qatarneh D, Claoue C. Alpha antagonists in cataract surgery. J Cataract Refract Surg 2005; 31: 2241
• 28 Pringle E, Packard R. Antipsychotic agent as an etiologic agent of IFIS. J Cataract Refract Surg 2005; 31: 2240-2241
• 29 Settas G, Fitt AW. Intraoperative floppy iris syndrome in a patient taking alfuzosin for benign prostatic hypertrophy. Eye (Lond) 12/2006; 20 (12) 1431-2 . Epub 2006 Feb 24
• 30 Shah N, Tendulkar M, Brown R. Should we anticipate intra-operative floppy iris syndrome (IFIS) even with very short history of tamsulosin?. Eye (London) 2009; 23: 740
• 31 Storr-Paulsen A. Management of Intraocular Floppy Iris Syndrome (IFIS) in Cataract Surgery. Chapter 11. In: Zaidi FH. (Hrsg.) Cataract Surgery. 1st ed. IntechOpen; 2013: 143-148 https://www.intechopen.com/books/cataract-surgery/management-of-intraocular-floppy-iris-syndrome-ifis-in-cataract-surgery
• 32 Taben R, Thakuria P, Jones M, Lohman LE. Intraoperative floppy-iris syndrome after one day of tamsulosin therapy. http://stream.expoplanner.com/ascrs2007/powerpoints/000092_IFIS_Case_ASCRS_Presentation.ppt
• 33 Teng CM, Guh JH, Ko FN. Functional identification of alpha 1-adrenoceptor subtypes in human prostate: comparision with those in rat vas deferens and spleen. Eur J Pharmacol 1994; 265: 61-66
• 34 Tiwari A. Tamsulosin and floppy iris syndrome in benign prostatic hyperplasia patients. Expert Opin Investig Drugs 2006; 15: 443-446
• 35 Yu Y, Ramage AG, Koss MC. Pharmacological studies of 8-OH-DPAT-induced papillary dilation in anesthetized rats. Eur J Pharmacol 2004; 489: 207-213
• 36 Zaman F, Bach C, Junaid I. et al. The Floppy Iris Syndrome - What Urologists and Ophthalmologists Need to Know. Curr Urol 2012; 6 (01) 1-7 . Epub 2012 Apr 30