Eyeworld

I WHAT YOUR PATIENT IS TAKING AND ITS EFFECT ON THE EYE N FOCUS 54 | EYEWORLD | JANUARY/FEBRUARY 2020 by Chiles Samaniego Contributing Writer use and to cover not only tamsulosin but also the other medications with the same mechanism of action." EyeWorld corresponded with Drs. Lee, Myers, and Steven Safran, MD, to discuss the effects of alpha-1 adrenergic antagonists (or blockers) on the eye and find out what ophthal- mologists need to know about their use. Iris changes Intraoperative floppy iris syndrome (IFIS) is the main concern when it comes to patients with a history of alpha-1 blocker use. "IFIS was first reported as an association by Campbell and Chang in 2005," 1 Dr. Myers said. "This creates increased risk of iris instability and pupil con- striction during cataract surgery, increasing the risk of complications. Most patients are male, but tamsulosin is also used in female patients with urinary flow issues." C ataract surgeons are seeing more pa- tients who have used—or are using— tamsulosin. "Tamsulosin is one of the most frequently used urologic agents in males for reduced urinary flow," Wil- liam Myers, MD, told EyeWorld. "As many patients undergoing cataract surgery have concomitant prostatic hypertrophy, many are already on or have tried tamsulosin. At the VA, nearly 75% patients are not naive with respect to alpha blockers." "A significant percentage of patients are taking these medications, most commonly for benign prostate hyperplasia," Bryan Lee, MD, JD, agreed. "However, they are used for other reasons, such as making it easier to remove a Foley catheter or to help pass a kidney stone. They are also being used more commonly in women, so it is important to ask for a history of Alpha-1 blockers, the iris, and ophthalmic surgery At a glance • While most frequently used in men to manage prostatic hy- pertrophy, alpha-1 adrenergic blockers are also used to ease the removal of a catheter and help pass a kidney stone. They are also being used by women. • Alpha-1 blockers effect irreversible histologic changes in the iris, with no direct relationship to dose or duration of use. • Pharmacological manage- ment with epinephrine and phenylephrine can be enough to manage a floppy iris, but iris hooks and rings can also be useful. • Ophthalmologists should be aware of other possible causes of IFIS, including diabetes and some viral infections. This is a patient on tamsulosin referred after complicated cataract surgery due to IFIS. There is iris damage and anterior and posterior capsule damage with dislocation of the IOL. Source: Steven Safran, MD

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