The Differential Risk of Intraoperative Floppy Iris Syndrome (IFIS) with Tamsulosin versus Other α1-Adrenergic Antagonists: A Systematic Review and Comparative Meta-Analysis
DOI:
https://doi.org/10.37275/bsm.v9i12.1463Keywords:
Alpha-1 adrenergic antagonists, Benign prostatic hyperplasia, Cataract surgery, Intraoperative floppy iris syndrome, TamsulosinAbstract
Background: α1-adrenergic antagonists are a cornerstone therapy for lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Their association with intraoperative floppy iris syndrome (IFIS) during cataract surgery is well-established, yet the comparative risk between the highly α1A-selective agent tamsulosin and other α1-blockers has not been adequately quantified in a meta-analysis. This study aimed to synthesize the evidence to determine the magnitude of this differential risk.
Methods: Following PRISMA guidelines, a systematic search was conducted across PubMed, Embase, Scopus, and the Cochrane Library through September 2025. We included comparative studies reporting IFIS incidence in adults on α1-blockers undergoing cataract surgery. Data were independently extracted by two reviewers. The primary outcome was the pooled Odds Ratio (OR) for IFIS, calculated using a random-effects model. Heterogeneity was assessed with the I² statistic.
Results: The search yielded 1,218 records, with six studies comprising 10,878 patients meeting the inclusion criteria. The incidence of IFIS was 18.7% in the tamsulosin group versus 2.9% in the comparator group (other α1-blockers or control). Tamsulosin was associated with a significantly greater risk of IFIS (Pooled OR = 4.28, 95% CI: 2.91–6.31, p < 0.00001). This corresponds to an absolute risk increase of 15.8% and a Number Needed to Harm (NNH) of 7, suggesting one additional case of IFIS occurs for every seven patients treated with tamsulosin instead of a different agent. Moderate heterogeneity was noted (I² = 62%).
Conclusion: This meta-analysis provides robust evidence that tamsulosin carries a more than four-fold increased odds of IFIS compared to other α1-blockers. This substantial and clinically meaningful risk, highlighted by an NNH of 7, mandates a risk-stratified approach to BPH management. A patient's present or future ophthalmological needs must be a central factor in the shared decision-making process when selecting an α1-blocker.
Authors
- Muhammad Adithia1*
- Boy Tri Janpiter1
- Ashabul Anhar1
- 1Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
Corresponding author Muhammad Adithia — muhammad.adithia@gmail.com
Article history
- Submitted
- Accepted
- Published
Downloads
Published
Issue
Section
License
Copyright and licensing
Copyright in each article remains with the author(s). Authors grant Bioscientia Medicina: Journal of Biomedicine and Translational Research a non-exclusive right of first publication and the right to identify itself as the original publisher. No exclusive transfer of copyright is required.
All articles are published under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License (CC BY-NC-SA 4.0): https://creativecommons.org/licenses/by-nc-sa/4.0/. Users may copy, redistribute, remix, transform, and build upon the material for non-commercial purposes, provided appropriate attribution is given, a link to the license is supplied, changes are indicated, and adaptations are distributed under the same license.
The license applies to the article's scholarly content unless a credit line states otherwise. Third-party material may be subject to separate rights. Authors retain patent, trademark, moral, and research-data rights. The copyright year follows the article's publication date.
