Prevention of tamsulosin-associated IFIS with intracameral phenylephrine 1.5% in 250 eyes

PURPOSE: To evaluate the efficacy of intracameral phenylephrine 1.5% as prophylaxis against tamsulosin-associated intraoperative floppy-iris syndrome (IFIS). METHODS: This prospective consecutive multicenter case series comprised 250 eyes from 210 patients receiving tamsulosin who underwent cataract surgery between May 2007 and October 2009 at three surgical sites (Complejo Hospitalario Orense, Lorente Clinica Oftalmologica, and Hospital de Verin. Orense. Spain) by four experienced surgeons. Routine topical mydriatics (tropicamide 1% and phenylephrine 10%) were instilled before surgery. After paracentesis, 0.6 cc of nonpreserved bisulfite-free phenylephrine 1.5% was injected into the anterior chamber. Standard phacoemulsification fluidic parameters and ophthalmic viscosurgical device preferences remained unchanged. Intraoperative iris billowing or prolapse and progressive miosis were assessed. RESULTS: There were no clinical manifestations of IFIS. No eye required placement of iris hooks or any additional maneuvers. Surgery was uneventful in all cases and no adverse events were detected. CONCLUSIONS: The absence of IFIS manifestations and adverse events in this large series of patients on tamsulosin strongly suggests that the single and simple measure of using intracameral phenylephrine 1.5% provides effective and total prophylaxis against IFIS.