Prospective multicenter evaluation of cataract surgery in patients taking tamsulosin (Flomax).
OBJECTIVE
Intraoperative floppy iris syndrome (IFIS) caused by systemic alpha-blockers has been associated with an increased risk of cataract surgical complications when the surgeon was unaware of the medication history and did not anticipate its occurrence. This study was undertaken to evaluate the surgical outcomes and rate of complications when the ophthalmologist knew the patient was taking tamsulosin (Flomax, Boehringer-Ingelheim Pharmaceuticals, Ridgefield, CT) and used 1 of several strategies to manage IFIS.


METHODS
Prospective multicenter nonrandomized observational series.


METHODS
A total of 167 consecutive eyes in 135 patients taking tamsulosin and undergoing cataract surgery.


METHODS
Phacoemulsification was performed in conjunction with at least 1 of 4 different IFIS management strategies, namely, topical atropine preoperatively, iris retractors, pupil expansion ring, or use of viscoadaptive ophthalmic viscosurgical device with reduced fluidic parameters.


METHODS
Severity of IFIS, incidence of operative or postoperative complications, and final visual acuity.


RESULTS
The IFIS severity was rated as mild in 17%, moderate in 30%, and severe in 43% of the study eyes. No IFIS was noted in 10% of the eyes. The rate of posterior capsule rupture and vitreous loss was 0.6% (1/167; 95% confidence interval, 0%-1.8%). Ninety-five percent of eyes achieved a best-corrected visual acuity of at least 20/40.


CONCLUSIONS
When experienced surgeons could anticipate IFIS and employ compensatory surgical techniques, the complication rate from cataract surgery was low and the visual outcomes were excellent in eyes of patients with a history of tamsulosin use.
Chang
David F
DF
Altos Eye Physicians, Los Altos, California, USA. dceye@earthlink.net
Osher
Robert H
RH
Wang
Li
L
Koch
Douglas D
DD
D058668:Adrenergic alpha-1 Receptor Antagonists; D000317:Adrenergic alpha-Antagonists / Q000009:adverse effects*; D001285:Atropine / Q000627:therapeutic use; D005127:Eye Color; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications; D007499:Iris Diseases / Q000139:chemically induced* / Q000188:drug therapy / Q000601:surgery; D019654:Lens Implantation, Intraocular; D008297:Male; D018918:Phacoemulsification; D011183:Postoperative Complications; D011446:Prospective Studies; D013449:Sulfonamides / Q000009:adverse effects*; D013577:Syndrome; D000077409:Tamsulosin; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology
D058668:Adrenergic alpha-1 Receptor Antagonists; D000317:Adrenergic alpha-Antagonists; D013449:Sulfonamides; D001285:Atropine; D000077409:Tamsulosin