The Problem with Flomax and Cataract Surgery

Myalugin ring used in patient with intraoperative floppy iris syndrome

Myalugin ring used in patient with intraoperative floppy iris syndrome

There is a drug side effect that is adversely affecting the treatment of cataracts by making the surgery more difficult and increasing the likelihood of surgical complications.

The drug causing this problem goes under the brand name, FLOMAX,  which is now usually generically filled as tamsulosin.

Tamsulosin works to relieve the symptoms of benign prostatic hypertrophy by relaxing smooth muscle. It’s in a class of drugs known as  “alpha-1 adrenergic antagonists,” and has a particular affinity for the sub-type alpha-1A receptors.

But as a side effect, it reduces the function of the radial dilator muscle of the iris, which is also specifically sensitive to alpha-1A adrenergic receptors.

Here is the issue – most of the tasks of cataract surgery are performed behind the pupil. As a rule, cataract surgery is safer with a large, dilated pupil because it improves the surgical exposure.

Unfortunately, the deleterious effects related to tamsulosin and eye surgery are often irreversible. It not only reduces pupil dilation, but there is a loss of dilator tone combined with tissue atrophy of the iris, resulting inINTRAOPERATIVE FLOPPY IRIS SYNDROME, also known by the acronym of IFIS (Cataract & Refractive Surgery Today, April 2005, pp 64-68).

Formerly, this was an unrecognized syndrome. It was fortuitously discovered by an eye surgeon in California, David Chang, at the University of California at San Diego.

Since that time, eye surgeons have had to make drastic modifications in technique to compensate for tiny pupils while at the same time preventing iris tissue from prolapsing through even the tiniest surgical incisions. The result is a longer and often more traumatic surgery, with an increased rate of complications.

Other oral medications for prostate hypertrophy can have a similar effect, but because they are not specific to alpha-1A adrenergic receptors, their effect is less severe. These include HYTRIN, CARDURA AND UROXATRAL. Another medication for BPH that has a different mechanism of action is AVODART.

We therefore recommend the following if you are being treated for  benign prostatic hypertrophy or other etiologies of urinary retention symptoms:

  • If you have not yet undergone cataract surgery and have BPH or another etiology of urinary retention, we recommend a consultation for cataract surgery PRIOR to receiving oral therapy with an alpha adrenergic agonist medication.
  • If you are unwilling to consider cataract surgery prior to institution of therapy or do not yet have cataracts, we recommend considering an alternative therapy to tamsulosin if other medications without specific activity against alpha-adrenergic-1A receptors are deemed safe by your urologist or internist.

While Dr. Krawitz utilizes the most advanced surgical techniques available to facilitate the best outcomes in these cases, we thought it was important to communicate to you regarding this important matter, so that you can more thoroughly evaluate your best course of action.

As always, we welcome your comments and inquiries. Our office address is Huntington Eye Care, 755 Park Avenue, Suite 100, Huntington NY 11743, just one building north of The Atrium.

Dr. Paul Krawitz has performed thousands of No Stitch-No Shot-No Patch Cataract Surgeries. He will personally take the time to thoroughly evaluate your unique situation and to speak to you about all of your options.  To make an appointment for a consultation and see the difference that personal attention and an experienced surgeon makes, call us at (631) 223-0400.