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In recent years,there are many studies have reported that a small pupil syndrome appeared during routine phacoemulsification in patients with current or previous use of alpha-1 adrenergic receptor antagonists,with these clinical manifestations:an iris that appears floppy as it billows during normal irrigation and aspiration in the anterior chamber,a tendency for the iris to prolapse and progressive intraoperative miosis during surgery,which called intraoperative floppy iris syndrome This article mainly reviews the mobidity,pathogenesis,clinical features,complications,prophylaxis and treatment of the intraoperative floppy iris syndrome.
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<b>Objective:</b> Tamsulosin is often administered at a dose of 0.2 mg in Japan, Korea, and elsewhere in Asia, while a dose of 0.4 mg is more common in the West. In order to determine the higher dose might also be appropriate in the North-East Asian setting, we studied whether the effect of increasing the dose to 0.4 mg in Japanese patients who had dysuria associated with benign prostatic hyperplasia.<b>Patients and Methods:</b> Twenty-two cases with a voiding volume ≥ 100 ml assessed by uroflowmetry out of 31 patients with benign prostatic hyperplasia and an IPSS (International Prostate Symptom Score) ≥ 8 whose symptoms were controlled with 0.2 mg of tamsulosin were entered into this study. We evaluated IPSS and QOL (quality of life) score, urinary flow parameters and residual urine volume before and 4 weeks after increasing the dose of tamsulosin.<b>Results:</b> Statistical analyses performed using the Wilcoxon test showed no significant alteration in IPSS total score or QOL score with the increased dose, but Qmax (maximum urinary flow rate) improved from 10.1 ± 5.5 ml/s to 12.1 ± 6.5 ml/s (p = 0.013), and residual urine volume improved from 37.6 ± 26.4 ml to 22.2 ± 24.3 ml (p = 0.012). Two of the 31 patients complained of new symptoms; 1 complained of breast pain and the other complained of dizziness.<b>Conclusions:</b> From the lack of side effects of more than moderate grade in the present study, increasing the dose of tamsulosin might be recommended before switching patients to other drugs.
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PURPOSE: Benign prostatic hyperplasia(BPH) describes a hyperplastic process of the stromal and epithelial elements of the prostate. The proliferative rates of each compartment in BPH may vary individually and the prostate is topographically not affected in a uniform way. The proposed mechanism of alphas-blockers in the treatment of BPH is the decrease of prostatic urethral resistance by relaxing the prostatic smooth muscle component present in the stroma. The purpose of this study is to search the effect of alphas-blockers according to histologic compositions in patients with BPH. MATERIALS AND METHODS: From January 1994 to June 1997, 74 patients were treated with alpha1-blockers(> or =1month) before prostatectomy. Of 74 patients, the international prostate symptom score(IPSS) was used in 62 patients to evaluate the severity of voiding difficulties. The clinical response to alpha1-blockers was based upon change in IPSS during medication period. According to histological compositions of prostatectomy specimen, the patients were classified into three groups: predominantly stromal type(20 patients), predominantly glandular type(21 patients) and mixed type(21 patients). RESULTS: There were 17 patients In response group and 45 patients in nonresponse group. The stromal type, glandular type and mixed type were composed of 52.9%, 17.7% and 29.4% respectively in response group and 24.4%, 40.1% and 35.5% respectively in nonresponse group. There was not statistical significant differences between clinical response of the alpha1-blockers and histologic compositions in patients with BPH(p>0.05). CONCLUSIONS: Although stromal type was predominant in response group and glandular type was predominant in nonresponse group, the relationship between the effects of alpha1-blockers and histologic compositions in patients with BPH was not statistically significant. Further evaluation will be necessary to assess the association between effects of alpha1-blockers and histologic difference of prostate in patients with BPH.