flomax_logoI’m going to take a break from discussing IOLs in order to summarize another very important talk given by David Chang, M.D. from UCSF. Really, anyone in the Bay area who needs cataract surgery should stongly consider at least an opinion from Dr. Chang. Mind you, I’ve never been in surgery with him and have absolutely no financial connections to him. However, his papers and presentations (which include videos of his work) are awe-inspiring among cataract surgeons (at least this one).

First, a little background on cataract surgery. Prior to cataract surgery the iris must be dilated in order for the surgeon to get to the lens (cataract). This is done both to obtain good visualization of the cataract and to protect the pupil which is a very delicate tissue and is easily damaged when it comes into contact with metal instruments.

Intraoperative Floppy Iris Syndrome (or IFIS).

Dr. Chang noted a few years ago that the iris of certain patients would become “floppy” during cataract surgery and dilation would be lost. This resulted in a very poor view through the small pupil, increased intraoperative complications (secondary to the poor view), and damage to the iris (because it flopped around inside the eye during surgery). This syndrome became known as Intraoperative Floppy Iris Syndrome (or IFIS).

David Chang, MD, and John R Campbell, MD, with the help of others (whose names I cannot recall – my apologies), collected all the information they could about these patients and discovered that they all had one thing in common: use of a prostate medication called Flomax®.

Flomax® and Cataract Surgery 

Flomax® (or tamsulosin) is a selective alpha-1 adrenergic antagonist that relaxes the smooth muscle of the prostate allowing men with Benign Prostatic Hyperplasia (BPH) to urinate more easily. Doctors also prescribe these medications for women as a treatment for urinary retention. Unfortunately, it appears that Flomax® has a permanent effect on the iris muscle that greatly increases the challenge of cataract surgery.

Other medications in this class include the newly released Rapaflo® (silodosin), as well as a group of medications termed “non-selective” alpha-1 adrenergic antagonists which include Hytrin® (terazosin), Cardura® (doxazosin), and Uroxatral® (alfuzosin). These non-selective drugs are less likely to result in IFIS.

Fortunately, if a cataract surgeon is aware that someone is taking one of these medications, he or she can take some additional precautions prior to or during cataract surgery to minimize the risks of IFIS. If you are taking any of the above medications or if your primary medical doctor is recommending that you start, it is a good idea to let your ophthalmologist know about it. If you don’t yet have an ophthalmologist, this would be a good time to get one.

© 2009 David Richardson, MD

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