Alpha-Blockers and Intraoperative Floppy Iris Syndrome: Ophthalmic Adverse Events Following Cataract Surgery

BackgroundWe investigated glaucoma related adverse events, predictors and impact at 5 years following surgery in the IoLunder2 cohortMethodsPopulation based observational cohort study of children undergoing cataract surgery aged 2 years or under between January 2009 and December 2010. Glaucoma was defined using internationally accepted taxonomies based on the consequences of elevated intraocular pressure (IOP). Glaucoma related adverse events were any involving elevated IOP. Multivariable analysis was undertaken to investigate potential predictors of secondary glaucoma with adjustment for within-child correlation in bilateral cataract. Unilateral and bilateral cataract were analysed separately.ResultsComplete follow-up data were available for 235 of 254, 93% of the inception cohort. By 5 years after primary cataract surgery, 20% of children with bilateral cataract and 12% with unilateral had developed secondary glaucoma. Glaucoma related complications had been diagnosed in 24% and 36% of children, respectively. Independent predictors of glaucoma were younger age at surgery (adjusted OR for reduction of week in age: 1.1, 95%C I 1.1 to 1.2, p<0.001); the presence of significant ocular comorbidity (adj OR 3.2, 95% CI 1.1 to 9.6, p=0.01); and shorter axial length (adj OR for each mm 1.7, 95% CI 10.0 to 1, p=0.05) for bilateral cataract. Shorter axial length was the single independent factor in unilateral disease (adj OR 9.6, 95% CI 1.7 to 52, p=0.009)ConclusionsBoth younger age at surgery (the strongest marker of ocular ‘immaturity’) and smaller ocular size (a marker of both immaturity and developmental vulnerability) can be used to identify those at greatest risk of glaucoma due to early life cataract surgery.

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The Effect of Preoperative Homatropine for Intraoperative Floppy Iris Syndrome in Patients Taken Alpha Blockers

Journal of the Korean Ophthalmological Society ◽

10.3341/jkos.2019.60.1.32 ◽

2019 ◽

Vol 60 (1) ◽

pp. 32

Author(s):

Hyun Sik Moon ◽

Jung Han Choi ◽

Byung Yi Ko ◽

Kyung-Chul Yoon

Keyword(s):

Alpha Blockers ◽

Intraoperative Floppy Iris Syndrome

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A Novel Sequential Docking Technique: Use of Femtosecond Arcuate Keratotomy and Femtosecond Assisted Cataract Surgery Using a Pupil Expansion Ring on a Patient with Intraoperative Floppy Iris Syndrome

International Medical Case Reports Journal ◽

10.2147/imcrj.s243809 ◽

2020 ◽

Vol Volume 13 ◽

pp. 139-144

Author(s):

Hung-Yuan Lin ◽

Ting-Yu Lin ◽

Ya-Jung Chuang ◽

Li-Ju Lai ◽

Pi-Jung Lin

Keyword(s):

Cataract Surgery ◽

Intraoperative Floppy Iris Syndrome

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MP44-04 THE ASSOCIATION OF ALPHA1A-ADRENOCEPTOR (ADRA1A) GENE SINGLE NUCLEOTIDE POLYMORPHISMS WITH ADVERSE EVENTS OF ALPHA BLOCKERS IN KOREAN BPH POPULATION.

The Journal of Urology ◽

10.1016/j.juro.2016.02.260 ◽

2016 ◽

Vol 195 (4S) ◽

Author(s):

Chung Lyul Lee ◽

Ki Hak Song ◽

Seung Woo Yang ◽

Young Seop Chang ◽

Jae Sung Lim ◽

...

Keyword(s):

Single Nucleotide Polymorphisms ◽

Adverse Events ◽

Nucleotide Polymorphisms ◽

Single Nucleotide ◽

Alpha Blockers

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New Look at Ocular Inflammation Control – Powerful and Fast-acting Twice-daily Bromfenac for a Novel Standard in the Treatment of Inflammation

European Ophthalmic Review ◽

10.17925/eor.2011.05.01.20 ◽

2011 ◽

Vol 05 (01) ◽

pp. 20 ◽

Cited By ~ 2

Author(s):

Hyung Cho ◽

Arash Mozayan ◽

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Keyword(s):

Intraocular Pressure ◽

Adverse Events ◽

Cataract Surgery ◽

Synergistic Effects ◽

Safety Data ◽

Ocular Inflammation ◽

Prostaglandin E ◽

Ophthalmic Surgery ◽

Inflammatory Conditions ◽

Increased Risk

Inflammation in the eye arising from various factors including allergy, infection, injury and surgery can have serious consequences, and can continue long after the cause is removed, resulting in permanently damaged vision. The treatment of ophthalmic inflammation after surgery has traditionally consisted of topical corticosteroids, but adverse events such as delayed healing, rise in intraocular pressure and increased susceptibility to microbial infections have driven the search for alternative treatments. Non-steroidal anti-inflammatory drugs (NSAIDs) have been used as alternatives to steroid treatments but also have limitations and cause adverse events. Bromfenac has emerged as a potent and safe treatment for inflammation after cataract surgery. Its unique chemical structure makes it a highly lipophilic molecule that penetrates all major ocular tissues in a rapid and sustained manner. It is also a potent inhibitor of the enzyme cyclo-oxygenase-2, which is believed to be the primary mediator of ocular inflammation. These properties permit less frequent dosing (twice-daily [BID]) and greater patient tolerability. A body of efficacy and safety data support use of bromfenac in this indication and it compares favourably with other NSAIDs and steroids in limiting post-operative inflammation. NSAIDs and corticosteroids have different, potentially synergistic effects. However, benefits specific to NSAIDs include lowering prostaglandin E-induced intraocular pressure elevation, no increased risk of secondary infections and stabilisation of the bloodaqueous barrier. With increasing demand for ophthalmic surgery, bromfenac and other treatments are likely to be important components in the treatment of inflammatory conditions after cataract surgery, decreasing pain and contributing to favourable visual outcomes.

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Treatment of Post-operative Inflammation following Cataract Surgery – A Review

European Ophthalmic Review ◽

10.17925/eor.2012.06.02.98 ◽

2012 ◽

Vol 06 (02) ◽

pp. 98 ◽

Cited By ~ 7

Author(s):

Harminder S Dua ◽

Richa Attre ◽

◽

Keyword(s):

Side Effects ◽

Adverse Events ◽

Cataract Surgery ◽

Healthcare Providers ◽

Surgical Techniques ◽

Ocular Inflammation ◽

Effective Control ◽

Loteprednol Etabonate ◽

Design Modification

Inflammation after cataract surgery, which can be persistent, remains an undesirable consequence despite many advances in surgical techniques. Although corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs) have traditionally been used to treat inflammation, prophylactically as well as post-operatively, there are no established guidelines for the treatment of inflammation induced by cataract surgery. The long-term use of corticosteroids has raised safety concerns, especially with regard to elevated intraocular pressure (IOP). This limitation of traditional corticosteroids led to the development of C-20 ester corticosteroids through retrometabolic drug design. This design modification allows the corticosteroid to be active at its site of action and then undergo predictable hydrolysis to inactive metabolites, resulting in reduced side effects. A review of studies published in the last 10 years indicates that C-20 ester corticosteroids provide effective control of post-cataract surgery inflammation without the elevation of IOP. Loteprednol etabonate ophthalmic suspension 0.5 % is the only topical C-20 ester corticosteroid approved for use in the treatment of corticosteroid-responsive inflammatory conditions including post-operative ocular inflammation. This corticosteroid, alone or in combination with NSAIDs, may provide effective and safe inflammation control, especially for high-risk patients, and may overcome concerns regarding side effects associated with traditional C-20 ketone corticosteroids. Ocular inflammation after cataract surgery presents healthcare providers with a treatment dilemma. While corticosteroids are traditionally the therapy of choice for inflammation, their long-term use for managing ocular inflammation can produce significant adverse events. This article discusses whether C-20 ester corticosteroids, alone or in combination with NSAIDs, offer effective treatment of post-cataract surgery inflammation while minimising adverse events.

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