Drugs can cause problems during cataract surgery

Eye surgeons need to know if patients are taking alpha-blockers to treat benign prostatic hyperplasia (BPH) because those drugs can cause complications during cataract surgery, say several national associations. Tamsulosin (Flomax, Boehringer Ingelheim Pharmaceuticals; Ridge-field, CT) and other alpha-blockers potentially can cause difficulty, particularly if the eye surgeon has not been forewarned, says the American Society of Cataract and Refractive Surgery (ASCRS), the American Academy of Ophthalmology, and the American Urological Association.

Other drugs in this alpha-blocker class include, terazosin (Hytrin, Abbott Laboratories, Abbott Park, IL), doxazosin (Cardura, Pfizer, New York City), and alfuzosin (Uroxatral, sanofi-aventis; Bridgewater, NJ). Such drugs also can be prescribed to women for urinary retention. Patients do not need to stop taking these drugs before cataract surgery, the associations said. Preliminary results of a new study found that these patients can have successful surgery if their eye surgeon knows they are taking or have taken these drugs and alters the surgical technique, according to ASCRS.

David F. Chang, MD, and John R. Campbell, MD, completed a retrospective and prospective study of 1,600 patients. They identified a condition named Intraoperative Floppy Iris Syndrome (IFIS) that occurs during cataract surgery in patients taking tamsulosin. Tamsulosin appears to block the iris dilator muscle, which causes problems with the iris during surgery, according to the ASCRS. The iris tends to be floppy, and the pupil suddenly can constrict during surgery, the association says. "If the iris problems are not anticipated or prevented, there is an increased risk of having surgical complications," the ASCRS said in a prepared statement. The syndrome was found in some patients who had not taken the medications in two years, according to the association.

The Food and Drug Administration instituted a new label warning for tamsulosin and other alpha-blocker drugs that reads, "The patient's ophthalmologist should be prepared for possible modifica- tions to their surgical technique." Surgeons can use small hooks to keep the pupil open or administer stronger dilating medicines directly inside the eye to avoid the syndrome, Chang said.1 An ASCRS task force has developed recommendations for surgical techniques to be used during cataract surgery on patients taking alpha-blockers. The American Academy of Ophthalmology will include this information in its Preferred Practice Pattern guide (PPPs) for cataract care that will be available free on its web site (www.aao.org) by the end of 2006. (Editor's note: To see the patient information sheet on prostate drugs and cataract surgery, go to www.ascrs.org/press_releases/upload/Patient-Information-Sheet-on-Prostate-Drugs-and-Cataract-Surgery.pdf. To see the journal study on IFIS, go to www.ascrs.org/press_releases/upload/Journal-Study-on-IFIS.pdf.)

Reference

  1. Associated Press. Prostate drug linked to cataract surgery troubles. Aug. 23, 2006. Accessed at www.theolympian.com/apps/pbcs.dll/article?AID=/20060823/NEWS/608230331/1011/LIVING03.