Prostate Drug Use May Mean Cataract Surgery Change

Flomax and other alpha-blockers may cause 'floppy iris syndrome,' but experts say simple eye drop change is all that's needed

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By Sid Kirchheimer
HealthDay Reporter

TUESDAY, Aug. 22, 2006 (HealthDay News) -- Men who have ever taken Flomax or other drugs known as alpha-blockers to treat an enlarged prostate may face some recovery problems from, of all things, cataract surgery.

The problem has prompted an alert from the three medical associations representing most of the specialties involved in eye surgery and prostate treatment: the American Academy of Ophthalmology, the American Society of Cataract and Refractive Surgery and the American Urological Association.

The organizations are urging that any cataract surgery applicant notify his doctor if he has taken Flomax (tamsulosin), Hytrin (terazosin), Cardura (doxazosin) or Uroxatral (alfuzosin) or any other drug categorized as an alpha-blocker.

Mentioning the use of these drugs will allow eye surgeons to take special precautions to reduce the risk of potential problems during surgery that could slow patients' healing and increase the risk of post-operative complications, said representatives from the medical societies. However, there is no evidence that the potential surgical complications from these drugs cause long-term damage or vision loss. And there's no reason for those with cataracts to stop the medications before having surgery, experts said. It's just that a different procedure may be called for, they added.

"You don't need to worry; you just need to inform your eye surgeon if you are currently taking, or have ever taken, Flomax or other alpha-blockers," said Dr. David F. Chang, clinical professor of ophthalmology at the University of California, San Francisco, School of Medicine.

Chang and fellow researcher Dr. John Campbell tracked 1,600 patients and found that current or prior use of Flomax -- and to a lesser extent, other alpha-blockers -- appeared to keep the muscle of the iris, (the colored part of the eye) from allowing the pupil (the opening in the iris) to stay completely open during cataract surgery with conventional eye drops. This dilation is necessary for surgeons to remove the clouded, cataract-covered lens beneath the pupil and replace it with an artificial lens.

Instead, Chang found that alpha-blocker use may cause the pupil to suddenly constrict during surgery, causing the iris to relax, a condition that Chang and Campbell termed "intraoperative floppy iris syndrome." This doesn't cause any eye disfigurement, but it can increase the risk of the surgeon tearing a portion of the eye that holds the artificial lens in place, Chang said.

"If we know that patients have ever used Flomax or the other drugs, we can use different, longer-lasting dilation eye drops or micro-hooks to keep the pupil completely dilated during surgery," Chang said. "Taking these measures, which eye surgeons normally wouldn't use, will prevent potential problems and result in an excellent prognosis. The issue is that when the pupil isn't completely dilated, surgeons just can't see what they're doing as well."

Based on the research, the medical associations jointly issued a patient advisory Aug. 22.

This followed an e-mail alert to eye surgeons initiated last year by Chang, warning about drug-related problems during cataract surgery.

In November 2005, the U.S. Food and Drug Administration approved a label change for the alpha blockers that read, "The patient's ophthalmologist should be prepared for possible modifications to their surgical technique," and it is now included in patient information material for Flomax.

Kate O'Connor, spokeswoman for Boehringer Ingelheim Pharmaceuticals Inc., maker of Flomax, said her company also had sent letters to ophthalmologists and urologists about the possible complications during cataract surgery.

A cataract is a vision-affecting clouding of the lens in the eye that increases with age. Cataracts typically begin to form after age 50 and, by age 80, more than half of all Americans either have a cataract or have had cataract surgery.

An enlarged prostate, or benign prostatic hyperplasia (BPH), also is age-related: By age 60, it affects half of men; by age 70, as many as 90 percent. It causes urination difficulty such as a weak stream, dribbling after urination, a feeling the bladder is not completely empty, and frequent overnight bathroom visits. To combat this problem, alpha-blockers help control the need for sudden and frequent urination, especially at night, by controlling a receptor in the prostate muscle.

The same receptor controls the dilation muscle in the iris and pupil, Chang said. Any alpha-blocker can trigger the sudden pupil dilation during surgery, but research indicates it's most evident from the use of Flomax, because it is less likely to cause sudden dizziness if a patient stands up too quickly.

More information

To more about the research being done concerning cataract surgery complications from alpha blockers, visit Eye World, the newsletter of the American Society of Cataract and Refractive Surgery.

SOURCES: David F. Chang, M.D., clinical professor, ophthalmology, School of Medicine, University of California, San Francisco; Kate O'Connor, spokeswoman, Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, Conn.; April 2005 Journal of Cataract and Refractive Surgery

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