Intraoperative floppy iris syndrome associated with tamsulosin

Abstract

Reply: We thank Nguyen and coauthors for their comments. In fact, the FDA is planning to add precautions regarding IFIS to the labeling for tamsulosin. We commented on IFIS and other α-1 blockers in our previous reply. We believe there is a range of severity of iris pathology in IFIS. For this reason, a particular pharmacological or surgical compensatory strategy may not be uniformly effective. While one would have expected that a drug-induced syndrome would improve with cessation of the medication, this was not always true in our experience. Nonetheless, it seemed that stopping tamsulosin helped in some cases. Tamsulosin has a particularly strong affinity for the α-1 receptor. The recommendation for a 1- to 2-week abstinence period reflected our suspicion that receptor binding might continue for some time beyond the disappearance of a plasma level of tamsulosin. We agree that patients may wish to consult with their urologist regarding an alternative medication during this temporary period. Given the variability in IFIS severity, a randomized or bilateral eye trial would be needed to conclusively determine whether stopping tamsulosin is effective in managing this problem. Of course, there would be little value in stopping tamsulosin if one planned to use iris retractors or a pupil expansion device. David F. Chang MD John R. Campbell MD