Multiple Drug Classes Can Up Risk for Floppy Iris Syndrome

TOPLINE:

Drug classes such as alpha-1 blockers, atypical antipsychotics, and tricyclic antidepressants were associated with an increased incidence of intraoperative floppy iris syndrome (IFIS), with imipramine, a tricyclic antidepressant, demonstrating the strongest association. Brinzolamide and salbutamol were disproportionately associated with the risk for the condition in women.

METHODOLOGY:

• Researchers conducted a population-based pharmacovigilance study to identify drugs most strongly associated with the incidence of IFIS and explore sex-based differences in these associations.
• They used data from the US Food and Drug Administration Adverse Event Reporting System between 2003 and 2024 and evaluated the association between more than 20,000 drugs and the incidence of IFIS.
• The analysis included more than 12.3 million unique reports of adverse events, of which 649 met the inclusion criteria for IFIS; 75.75% were reported by healthcare professionals, 12.69% by consumers, and 11.57% by unknown sources.

TAKEAWAY:

• In this study, alpha-1 blockers, tricyclic antidepressants, atypical antipsychotics, carbonic anhydrase inhibitors, corticosteroids, 5-alpha reductase inhibitors, beta-blockers, prostaglandin analogs, and beta-2 agonists were linked to cases of IFIS.
• Imipramine demonstrated the highest disproportionate association with the incidence of IFIS (reporting odds ratio [ROR], 251.66), followed by tamsulosin, an alpha-1 blocker (ROR, 171.44), and chlorpromazine, an atypical antipsychotic (ROR, 91.30; P < .0001 for all).
• Use of brinzolamide, a carbonic anhydrase inhibitor (ROR, 409.63), and salbutamol, a beta-2 agonist (ROR, 67.12; P < .0001 for both), was disproportionately associated with the incidence of IFIS among women but not among men.

IN PRACTICE:

“Sex-based differences in IFIS risk factors and outcomes warrant attention,” the authors of the study wrote. “Identifying additional medications that may contribute to IFIS is critical for enhancing preoperative risk assessment and optimizing surgical management strategies,” they added.

SOURCE:

This study was led by Moiz Lakhani, MD(C), from the Faculty of Medicine at the University of Ottawa in Ottawa, Ontario, Canada. It was published online on March 18, 2025, in the American Journal of Ophthalmology.

LIMITATIONS:

Spontaneous reporting systems may be subject to biases, such as underreporting and incomplete documentation. Causation could not be established due to inherent limitations of pharmacovigilance data. Estimating the size of the population at risk proved challenging due to multiple factors.

DISCLOSURES:

This study did not receive any funding, and the authors declared having no financial support or conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.