Prospective Multicenter Evaluation of Cataract Surgery in Patients Taking Tamsulosin (Flomax)
Presented at: American Academy of Ophthalmology Annual Meeting, November 2006, Las Vegas, Nevada.
Received 25 September 2006; accepted 10 January 2007.
Purpose
Intraoperative floppy iris syndrome (IFIS) caused by systemic α-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.
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.
Main Outcome Measures
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.
Conclusion
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.
3Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas.
Correspondence to David F. Chang, MD, 762 Altos Oaks Drive, Suite 1, Los Altos, CA 94024.
Manuscript no. 2006-1066.
The authors have no direct financial interest in any material or method mentioned. Drs Chang, Osher, and Koch are consultants for Advanced Medical Optics and Alcon.
ABSTRACT