Incidence and Risk Factors of Intraoperative Floppy Iris Syndrome During Cataract Surgery

PURPOSE: To determine the incidence and risk factors of intraoperative floppy iris syndrome (IFIS) in patients undergoing cataract surgery. METHODS: The present study included 981 eyes of 655 patients who underwent cataract surgery and development and grade of IFIS were recorded. Correlation analysis was performed to determine the relationship between the IFIS and risk factors such as alpha1-adrenergic antagonist (tamsulosin, terazosin, alfuzosin), benzodiazepine, 5-alpha-reductase inhibitor, age, gender, hypertension, diabetes and glaucoma. RESULTS: IFIS developed in 178 eyes (18.1%) out of 981 eyes. There was a correlation between the development of the IFIS and alpha1-adrenergic antagonist and benzodiazepine and male gender; however, there was no correlation with 5-alpha-reductase inhibitor, age, gender, hypertension, diabetes and glaucoma. IFIS grade tended to be higher as the cumulative dosage of the alpha1-adrenergic antagonist increased. Odds ratio of the patients using tamsulosin was the highest among the other risk factors, which was 3.8 times higher than the patients using terazosin, 9.0 times higher than the patients using alfuzosin and 11.1 times higher than the patients using benzodiazepine. Among patients who underwent cataract surgery on both eyes and who were confirmed with IFIS in 1 or both eyes, no significant grade differences between the 2 eyes were noted. CONCLUSIONS: Alpha 1-adrenergic antagonist and benzodiazepine were risk factors for the development of the IFIS, and as the cumulative dosage of the alpha1-adrenergic antagonist increased, the probability of developing a higher grade of IFIS increased. Therefore, predicting and preparing for potential IFIS in patients who have the above-mentioned risk factors are necessary before planning cataract surgery. Additionally, the IFIS aspect of the first eye could be utilized as a predictive value for developing IFIS profile of the fellow eye.

Prazosina de liberação lenta para pacientes com transtorno do estresse pós-traumático resistentes aos ISRS / Slow-release prazosin for SSRI-resistant posttraumatic stress disorder patients

CONTEXTO: Prazosina, um antagonista de receptores alfa-1 adrenérgicos, é utilizada no tratamento de pesadelos e insônia relacionados com TEPT. Apesar das evidências sugerindo sua eficácia também no tratamento de sintomas gerais de TEPT, sua curta meia-vida (2-3 horas) pode limitar seus efeitos terapêuticos.OBJETIVO: Descrever quatro casos de pacientes com TEPT resistentes aos inibidores de recaptação de serotonina ou de serotonina e adrenalina (terapia convencional) tratados com uma apresentação de prazosina de liberação lenta.MÉTODOS: Quatro pacientes com TEPT grave, resistentes à terapia convencional, tiveram a prazosina de liberação lenta (meia-vida de 10,8 horas) adicionada as suas prescrições por pelo menos três meses. Os sintomas de TEPT foram avaliados pela PCL-C e pelos itens referentes a pesadelos e insônia da CAPS, na linha de base e no final do período de observação de cada paciente.RESULTADOS: Dois pacientes mostraram melhora dos sintomas gerais de TEPT (redução de 35,7% e 11,9% nos escores da PCL-C), e três mostraram melhora de pesadelos e insônia (nos escores da CAPS). O único paciente que recebeu doses da prazosina pela manhã e ao deitar-se foi o que mostrou a maior melhora dos sintomas gerais de TEPT.CONCLUSÃO: Possivelmente, a sustentação do bloqueio da atividade noradrenérgica no sistema nervoso central promovida pela prazosina de liberação lenta durante o dia se faz necessária para a melhora de sintomas residuais de TEPT em pacientes em tratamento convencional com antidepressivos.

BACKGROUND: Prazosin is an antagonist of alpha-1 adrenergic receptor used to treat PTSD-related nightmares and insomnia. Although evidence suggests that it is also effective in the treatment of general symptoms of PTSD, its short half-life (2-3 hours) may limit its therapeutic effects.OBJECTIVE: To describe four cases of patients with PTSD resistant to selective serotonin reuptake inhibitors (SSRIs) or selective serotonin/noradrenaline reuptake inhibitor (SNRIs) therapy (conventional therapy) treated with slow-release prazosin presentation.METHODS: Four patients with severe PTSD resistant to conventional therapy received slow-release prazosin (half-life of 10.8 hours) added to their prescription for at least three months. PTSD symptoms were evaluated by the PCL-C, together with nightmares and insomnia items of CAPS, at baseline and at the last observation of each patient.RESULTS: Two patients showed improvement in general symptoms of PTSD (reduction of 35.7% and 11.9% in PCL-C scores), and three showed relief from nightmares and insomnia (CAPS scores). The only patient who received morning and bedtime doses of prazosin showed the greatest improvement in general symptoms of PTSD.DISCUSSION: It is possible that the sustained blockade of noradrenergic activity in the central nervous system provided by slow-release prazosin during the day is necessary to further ameliorate residual PTSD symptoms in patients receiving conventional antidepressant therapy.