Download CATARACT SURGERY AND GENITOURINARY MEDICATIONS

CATARACT SURGERY AND GENITOURINARY MEDICATIONS
Frank J. Weinstock, MD, FACS
When you have any surgery performed it is essential that you tell your surgeon all of the
medications that you take since many may interfere with your surgery, such as causing
bleeding, untoward reactions to anesthesia etc.
One of the main concerns is the group of men who have BPH (benign prostatic hypertrophy)
and are given Flomax (tamsulosin). Because of extensive advertising of Flomax, it is often
assumed that it is totally safe (warnings are mentioned if you pay attention). However, when
undergoing cataract surgery, patients using Flomax have a significantly high number of
complications than those who do not use it. In an article by David Chang, MD, it is mentioned
that the risk of severe postoperative complications such as retinal detachment is 2.3 tunes the
incidence of other patients who do not use the medication.
What happens is that the iris (the colored portion of the eye around the pupil) becomes
“floppy” in some of these patients This is called the IFIS or floppy iris syndrome. Since, in
cataract surgery, it is necessary to dilate or enlarge the pupil in order to perform the surgery,
inability to dilate the pupil may lead to major complications. Although well know to most
ophthalmologists, primary care physicians are often not familiar with this. Therefore, it is
essential that your ophthalmologist and primary care physician know about these medications
beforehand. In one of Dr. Chang’s studies, the “floppy iris syndrome” showed up in patients in
up to 2 years after stopping Flomax.
In one study by ASCRS (The American Society of Cataract and Refractive Surgery), 95% of
surgeons felt that tamsulosin made cataract surgery more difficult and 77% felt that the risks
of complications were greater. 95% would try to avoid it for themselves if they had cataracts.
What can the patient do? First, be sure to notify your ophthalmologist that you are using
tamsulosin (Flomax). Ask your surgeon if he or she feels comfortable doing the cataract
surgery. Recognize that most ophthalmologists have experience dealing with this meaning that
they can usually avoid surgical complications and rarely have problems if they know about
Flomax prior to surgery.
If you have cataracts and require medications for BPH, discuss this with your physician and
you may want to ask him or her to consider other medications since the other medications
available do not seem to cause a problem, especially if you have not used Flomax beforehand.
It might be a good idea for your primary care physician or urologist to communicate with your
ophthalmologist about this.
Frank J. Weinstock, MD, FACS
Boca Pointe- Canton, Ohio
Professor of Ophthalmology- NEOUCOM
Affiliate Clinical Professor in The Charles E. Schmidt College of Biomedical Science at
Florida Atlantic University, Boca Raton.
Volunteer Professor of Ophthalmology – The University of Miami Leonard M. Miller
School of Medicine