Prior to cataract surgery the iris must be dilated in order for the surgeon to get to the lens (or 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.
A few years ago an ophthalmologist in the bay area, Dr. David Chang noted that the iris of certain patients would become “floppy” during cataract surgery and dilation of the pupil 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).
Drs. David Chang, and John Campbell, with the help of others 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® (or tamsulosin) is a medication 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 though it can still happen.
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, I need to know this prior to cataract surgery.
You don’t have to wait to hear the rest of the Audio series. The entire Cataract Surgery Essentials Audio Series (including the audio for this post) is now available as a CD that can be purchased online from CDBaby or eBay (just search “Cataract Surgery Essentials” to find it). Or, you are welcome to stop by my San Gabriel office and pick up a copy.
