EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/1199001
I JANUARY/FEBRUARY 2020 | EYEWORLD | 55 sulosin use, and conducted light microscopic review and morphometric analysis of the eyes, measuring the maximum and minimum iris dila- tor muscle thickness and iris stromal thickness. The group found that the "mean iris dilator muscle thickness in the tamsulosin-treated group (6.53±1.99 µm) was significantly thin- ner compared with that of the control group (8.50±1.61 µm)(p=0.006)," though no direct relationship was found between the iris changes and the dose and duration of tamsulosin use. Because the effect is irreversible, the doc- tors agreed that there is no point asking the pa- tient to stop using the blocker prior to surgery. "I never ask patients to stop, I just want to make sure that I know about a history of current or prior use," Dr. Lee said. "The only reason to stop the medication is if they just started it," Dr. Safran said. "If they In his experience, alpha-1 blockers can affect the iris after just one dose. "I cared for a patient with IFIS who had to stop tamsulosin after a single dose as he had a neuroleptic sei- zure develop," he said. Dr. Safran offered a different experience. "Some patients are on these medications for years with little effect and others within a few months can see an effect," he said. However, he emphasized that "[t]he effect once it kicks in is permanent because there are histologic changes to the iris with atrophy of the dilator muscles." These changes were detailed by Ricar- do Santaella, MD, and colleagues in a paper published in Ophthalmology. 2 The retrospective, case-control study involved 51 cadaveric eyes from 27 patients—14 of whom used tam- sulosin, leaving 13 in the control group. Dr. Santaella and his colleagues reviewed patient histories, recorded duration and dosage of tam- About the doctors Bryan Lee, MD, JD Altos Eye Physicians Los Altos, California William Myers, MD Myers Center for the Eye Skokie, Illinois Steven Safran, MD Lawrenceville, New Jersey continued on page 56 The IOL has dislocated into the back of the eye and is sitting on the retina. One haptic appears to be kinked. Source: Steven Safran, MD