Jun 27, 2009
A new landmark study has shown that men taking Flomax (tamsulosin) have twice the risk of serious complications after cataract surgery. The study out of Canada collected data on over 96,000 men who had cataract surgery. The higher risk of complications was found in the men taking Flomax within14 days of the surgery, but not in men taking other medications for BPH (benign prostatic hyperplasia.) The complications noted included retinal detachment, lost lens fragment, infection and inflammation.
How does Flomax affect cataract surgery. It's called Intraoperative Floppy Iris Syndrome (IFIS) and in basic terms it can make the iris very loose and floppy so that it doesn't dilate well for the cataract surgery and often causes the pupil to un-dilate during the surgery. The floppy iris can billow about like a sheet in the wind, can get sucked up in the phaco-emulsification tip or squirt out of the surgical incision. I've even seen the iris try to go out of the tiny 1 mm side port incision. The effect can be so great at times that tiny flexible iris retractors are sometimes needs to physically hold the iris out of the way for the cataract surgery.
My personal estimate in my practice is that about one in 12 men getting ready for cataract surgery are currently taking or have taken Flomax. It is a very, very popular drug, and to be honest does an incredible job for those with serious BPH and urinary issues. Even if patients have been off of Flomax for a several years, I still include them in my Flomax protocol group since the iris effects of Flomax do not necessarily go away when the drug is stopped.
For my patients getting ready for cataract surgery, I ask them to stop Flomax for 2 weeks prior to surgery. In the operating room, we often utilize intraocular epinephrine solution to dilate and stiffen the iris, and alway use a thicker viscoelastic agent to hold the iris in its place. Also, careful consideration is given to make sure the incision dives well over the peripheral iris and a very tight incision is essential to reduce iris prolapse through the incision during the case. I very rarely need to use iris retractors anymore (none in the last 18 months) despite operating on about 2 Flomax cases each week. I haven't personally seen a greater incidence of major complications, but I have seen a few cases with minor damage to the iris, especially near the incision. Some of these cases can be much more difficult at times, however, and they have contributed to some extra gray hairs. I attribute my low complication rate to the great contributions by surgeons like David Chang, who have popularized protocols using stronger dilating drops, thicker visco-elastics, low flow infusions, and epinephrine mixtures. I will tell you it makes all the difference in the world.
I want men to know that if they are considering taking Flomax, they should carefully consider how it will affect their cataract surgery in the future. I very strongly urge you to at least look carefully into other options for treatment of BPH symptoms. As a cataract surgeon, I know that I would want to avoid this drug if I knew that I might need cataract surgery someday down the road. If you are already taking Flomax, you should know that you can still have safe cataract surgery and should not stop the drug unless under the direction of your doctor. Your cataract surgeon will most likely ask you to discontinue it for a while (if possible) around the time of your cataract surgery. You don't want your iris to be "floppy" do you.
Michael Kutryb, MD