Groups issue advisory about alpha-blockers, iris syndrome

October 1, 2006

Linthicum, MD-AUA has partnered with two leading ophthalmology groups to raise awareness that individuals with past or present use of an alpha-1 blocker may develop a condition known as intraoperative floppy iris syndrome (IFIS) while undergoing cataract surgery and should inform their ophthalmologist about such medication use so that appropriate surgical techniques can be used.

Linthicum, MD-AUA has partnered with two leading ophthalmology groups to raise awareness that individuals with past or present use of an alpha-1 blocker may develop a condition known as intraoperative floppy iris syndrome (IFIS) while undergoing cataract surgery and should inform their ophthalmologist about such medication use so that appropriate surgical techniques can be used.

Other currently marketed alpha-blockers are alfuzosin (Uroxatral), doxazosin (Cardura), and terazosin (Hytrin).

"The alpha-1 blockers are a commonly prescribed group of medications, particularly for men with BPH, but they are also used to treat other men and women with lower urinary tract symptoms." said Lawrence S. Ross, MD, AUA president. "Therefore, it is critical to recognize that the potential for IFIS is with a class of drugs and not just with their use in men with BPH.

A similar advisory was issued by the Council for Refractive Surgery Quality Assistance about patients who are taking alpha-blockers and who may be considering undergoing refractive lens exchange, an alternative to Lasik laser eye surgery.

Studies indicate that the risk of IFIS is not eliminated by discontinuation of the alpha-blocker. In fact, IFIS has occurred in patients who had stopped taking an alpha-blocker up to 5 years earlier, so it is critical that patients be informed to indicate any past use to their ophthalmologist if they are candidates for cataract surgery.

"Stopping one of these agents abruptly can result in urinary retention, especially in men with prostatic disease, and that risk may be further increased in this situation because atropine treatment is one of the strategies used by cataract surgeons to manage IFIS," noted Dr. Ross, who is professor and head of urology at the University of Illinois, Chicago.

To inform urologists of the issues concerning alpha-blockers, AUA sent a press release to all members via e-mail, Dr. Ross said. In addition, updates to AUA practice guidelines will address these matters when appropriate.