A Case of Intraoperative Floppy Iris Syndrome in a Patient Using Tamsulosin

PURPOSE: To report a case of Intraoperative Floppy Iris Syndrome (IFIS) experienced during pars plana vitrectomy and phacoemulsification in a patient using tamsulosin, which is a selective alpha 1 adrenergic antagonist. CASE SUMMARY: A 77-year-old male who had used tamsulosin for the previous month for prostate cancer visited our clinic with left visual disturbance, that had developed a week earlier. The best-corrected visual acuity of the left eye was 0.02 and both pupils showed incomplete mydriasis. Pars plana vitrectomy and phacoemulsification with PCL implantation were performed on his left eye to correct a left cataract and retinal vein occlusion with vitreous hemorrhage. Phacoemulsification idenfied a billowing iris and progressive pupillary constriction. Therefore, we administered an intracameral epinephrine injection and applied an iris hook. The procedure was completed successfully without any complications. The best-corrected visual acuity of the left eye was good as at 0.9, and iris depigmentation and atrophy were checked two months postoperatively in the right eye, which had not had any previous surgical history. CONCLUSIONS: A detailed medical history taking is essential because IFIS may raise the risk of intraoperative complications, such as posterior capsule rupture, especially when the small pupil is small. Safe procedures must be planned with cessation of tamsulosin at least a week preoperatively.

Doxazosin in the Symptomatic Treatment of Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: This study set out to investigate the safety and efficacy of doxazosin treatment in symptomatic patients with benign prostatic hyperplasia(BPH) in Korea. MATERIALS AND METHODS: A total of 237 male patients aged 50 or over with clinical evidence of BPH were enrolled into this 12-week, open, baseline-controlled, dose-response study. A run-in period of 2 weeks placebo treatment was followed by 10 weeks of doxazosin treatment. The initial dose was 1mg per day which, at 2-week intervals, could have been titrated up to 2, 4, or 8mg per day. Efficacy, in terms of International Prostate Symptom Score(I-PSS) and blood pressure(BP), was assessed from Week 6 onwards. RESULTS: A total of 180 patients(mean age 65.3 years) completed the study, with the most common reason for withdrawal being lost to follow-up(35 cases); four patients were withdrawn due to adverse events. Mean I-PSS score was reduced by 48.8%(from 21.5 at baseline to 11 at completion). Subset analysis of normo- or hypertensive patients showed that in the 26 hypertensive patients mean systolic BP was reduced by 12.3%(-19mmHg) and mean diastolic BP by 13.7%(-14mmHg), whereas in normotensive patients the reductions were 4.0%(-5mmHg) and 1.9%(-1.5mmHg), respectively. No differences in I-PSS improvements were seen between these two groups. The effects of age were also investigated and showed no significant differences in the changes in blood pressure for older patients(> or =65 years; n=91 ) compared with younger patients(7.5/5.8mmHg compared with 6.5/5.0mmHg). There were no differences in I-PSS improvement. Twenty eight adverse events were reported by 16 patients, the most commomly reported events being dizziness, postural hypotension, and headache. CONCLUSIONS: The effectiveness and safety of doxazosin in the treatment of BPH was confirmed in this Korean population, with significant improvements in I-PSS regardless of patient age and blood pressure at baseline. The baseline I-PSS was higher than is commonly seen in European populations, indicating a greater disease severity.

The Effect of 0.1% Topical Bunazosin(R) on the lOP of Normal Subjeets

The effects of topically applied bunazosin hydrochloride, Which has been developed as a highly selective alpha-1 adrenergic antagonist, on intraocular pressure(IOP), pupillary diameter, conjunctival injection, ptosis, and blood pressure were investigated in 14 normal volunteers. It is known that the mechanism of lOP reduction appears to be an increase in uveoscleral outflow and/or a decrease in episcleral venous pressure. The purpose of this experiment is to observe the effects of 0.1 % Bunazosin(R) on the lOP, pupil size, lid, conjunctival change and blood pressure in the normal human subject. The effects of 0.1% topical bunazosin(R) have been observed with placebo-controlled, double-blind single-dose study. The drug reduced lOP for 10 hours, and the decrease was statistically significant(p value <0.05). The lOP was decreased maximally at 3 hours after the instillation of the drug and the amount of the lOP reduction was 4.2mmHg. There were no significant changes of pupil size, lid configuration, conjunctival injection, and blood pressure in this experiment.