Eyeworld

78 | EYEWORLD | APRIL 2019 C by Maxine Lipner EyeWorld Senior Contributing Writer Contact information Campbell: rob.campbell@queensu.ca RESEARCH HIGHLIGHT ATARACT T amsulosin remains a commonly used drug for prostate hyperplasia. When it comes to the effect of tamsulosin use on cataract complications, investigators in a population-based study 1 led by Robert Campbell, MD, FRCSC, determined that the rate associated with intraoperative floppy iris syndrome has been dropping over a 10-year period. Several of the group's investigators were among those who had worked years earlier helping to show the risk of tamsulosin in those undergoing cataract surgery and wanted to know what had become of such patients as awareness has grown. "Often when surgeons know there's a problem, they can anticipate it," Dr. Campbell said. "They develop new techniques and devices to try to deal with the problem, and we wanted to know whether those things made a difference in the real world at a population level." Population-based study Included in the study were all patients who had cataract surgery in Ontario, which is Canada's largest province with 13 million people. "But we looked only at men because the vast majority of people who use the drug are men," Dr. Campbell said. As part of the study, investigators considered two groups to determine whether outcomes had improved over time: those who had used tamsu- losin and those who had not. "Interestingly, we found that things had improved in both groups," Dr. Campbell said. The idea was to look at four outcomes that occur after cataract surgery—pos- terior capsule rupture, endophthalmitis or infec- tion, dropped lens fragments requiring vitrectomy, and retinal detachment—and consider how these rates had changed over time. The timeframe considered was from 2003 to 2013. "We chose that period because it overlaps the first description of intraoperative floppy iris syndrome, which is associated with tamsulosin and which was described in the literature only around 2005," he said. "That was the period we thought would be the highest because no one even knew this was a problem, and they kept encountering these unexpected problems intra- operatively." With time as people tried different techniques to prevent tamsulosin-associated complications, the thinking was that these would diminish. At the start, investigators found that the overall adverse event rate was only about 1% and went down over time. "It went from just over 1% to less than 1% over the 10 years," Dr. Campbell said. Practical implications Still, practitioners must be watchful when faced with a cataract patient who has taken tamsulosin. Does tamsulosin remain on cataract practitioners' radars? Iris damage during phaco in a case of floppy iris syndrome Source: Daljit Singh, MD About the doctor Robert Campbell, MD, FRCSC Professor of ophthalmology Queen's University Kingston Health Sciences Center Ontario, Canada Reference 1. Campbell RJ, et al. Evolution in the risk of cataract surgical complications among patients exposed to tamsulosin: a population-based study. Ophthalmology. 2019;126: 490–496. Financial interests Campbell: None "Half the battle is in knowing that they might have intraoperative floppy iris syndrome and knowing that if you did nothing other than to go slowly and carefully, this would reduce the risks." —Robert Campbell, MD, FRCSC

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