Reactions 1420 - 22 Sep 2012

★ SImipramine

First report of floppy iris syndrome: 3 casereports

Three men who had received or were receivingimipramine for depression developed floppy iris syndromewhile undergoing phacoemulsification under localanaesthesia for cataracts.

A 65-year-old man had received oral imipramine 25mgtwice daily for 25 years. He underwent phacoemulsificationin both eyes. Pre-operatively, his pupil dilated to 6.0mm.During the procedure, features of intraoperative floppy irissyndrome appeared: iris stroma was flaccid, and billowed,undulated and prolapsed through the main and sideincisions; progressive miosis occurred. Adrenaline[epinephrine] was administered, and the floppy iris andmiosis did not improve appreciably. Thephacoemulsification procedure was completed withoutcomplication, and the intraocular lens successfullyimplanted into the capsular bag; 20/20 vision was restored.

A 60-year-old man had received oral imipramine 25mgonce daily for 10 months; therapy was stopped 4 monthsbefore he underwent phacoemulsification in his left eye.Pre-operatively, his pupil dilated to 5.0mm. During theprocedure, partial features of intraoperative floppy irissyndrome developed: the iris undulated and progressivemiosis occurred. Adrenaline was administered, but did notsignificantly reduce the floppy iris syndrome features. Irishooks were needed as pupil size had decreased to 3mm.The phacoemulsification procedure was completedwithout complication, and the intraocular lens successfullyimplanted into the capsular bag; 20/20 vision was restored.

A 58-year-old man had received oral imipramine 25mgonce daily for a year, and had stopped 2 months prior toundergoing phacoemulsification in his left eye. Pre-operatively, his pupil dilated to 5.5mm. During theprocedure, features of intraoperative floppy iris syndromeappeared, and progressive miosis occurred. Adrenalinewas administered without effect, and iris hooks were used.The phacoemulsification procedure was completedwithout complication and the intraocular lens successfullyimplanted into the capsular bag; 20/20 vision was restored.

Author comment: "Imipramine leads to chronic blockageof α-1 [adrenoceptors] of pupillary dilator muscle, whichmight result in atrophy of the iris stroma and hence can leadto the occurrence of [intraoperative floppy iris syndrome]".Gupta A, et al. Floppy iris syndrome with oral imipramine: a case series. IndianJournal of Ophthalmology 60: 136-8, No. 2, Mar-Apr 2012 - India 803077244

» Editorial comment: A search of AdisBase, Medline,Embase, and the WHO ADR database did not reveal anyprevious case reports of floppy iris syndrome associatedwith imipramine.

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Reactions 22 Sep 2012 No. 14200114-9954/10/1420-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved