JAMA: Cataracts/Lens Topic Collection

Tamsulosin and the Intraoperative Floppy Iris Syndrome

Friedman AH. — Wed, 20 May 2009 00:00:00 GMT

The intraoperative floppy iris syndrome (IFIS) was first described by Chang and Campbell in 2005. These authors and others observed that there was a tendency for poor pupillary dilation and the intraoperative triad of the billowing of a flaccid iris, the propensity for iris prolapse, and progressive intraoperative pupillary constriction. In the current technique ophthalmologists perform cataract surgery through a 2.5-mm incision. A widely dilated pupil is essential for complication-free surgery. Billowing of the iris into the surgical field and poor pupillary constriction are potentially catastrophic barriers to successful surgery. Intraoperative floppy iris syndrome is encountered mainly in cataract surgery and in prospective studies has been found to occur in 2% to 3% of all cataract operations and to a lesser extent in glaucoma surgery.

Association Between Tamsulosin and Serious Ophthalmic Adverse Events in Older Men Following Cataract Surgery

Bell CM, Hatch WV, Fischer HD, et al. — Wed, 20 May 2009 00:00:00 GMT

Context

Both benign prostatic hyperplasia (BPH) and cataract formation are common in older men. The α-adrenergic receptor blocker tamsulosin is frequently prescribed to treat BPH, and research suggests this drug may increase the intraoperative difficulty of cataract surgery. No studies have documented whether use of tamsulosin or other α-blocker drug therapies affect the risk of serious postoperative adverse events.

Objective

To assess the risk of adverse events following cataract surgery in older men prescribed tamsulosin or other α-blocking drugs used to treat BPH.

Design, Setting, and Patients

Nested case-control analysis of a population-based retrospective cohort study using linked health care databases from Ontario, Canada. We included all men aged 66 years or older who had cataract surgery between 2002 and 2007 (N = 96 128).

Main Outcome Measures

A composite of procedures signifying retinal detachment, lost lens or lens fragment, or endophthalmitis occurring within 14 days after cataract surgery. The risk of these adverse events was compared between men treated with tamsulosin or other α-blockers and men with no exposure to these medications in the year prior to cataract surgery. We separately examined the association of drug exposure that was either recent (within the 14 days before surgery) or previous (15-365 days before surgery).

Results

Overall, 3550 patients (3.7%) in the cohort had recent exposure to tamsulosin and 7426 patients (7.7%) had recent exposure to other α-blockers. Two hundred eighty-four patients (0.3%) had an adverse event. We randomly matched 280 of the cases to 1102 controls according to their age, surgeon, and year of surgery. Adverse events were significantly more common among patients with recent tamsulosin exposure (7.5% vs 2.7%; adjusted odds ratio [OR], 2.33; 95% confidence interval [CI], 1.22-4.43) but were not associated with recent exposure to other α-blockers (7.5% vs 8.0%; adjusted OR, 0.91; 95% CI, 0.54-1.54) or to previous exposure to either tamsulosin (≤1.8% vs 1%; adjusted OR, 0.94; 95% CI, 0.27-3.34) or other α-blockers (2.9% vs 2.1%; adjusted OR, 1.08; 95% CI, 0.47-2.48). This corresponds to an estimated number needed to harm (NNH) of 255 (95% CI, 99-1666).

Conclusions

Exposure to tamsulosin within 14 days of cataract surgery was significantly associated with serious postoperative ophthalmic adverse events. There were no significant associations with exposure to other α-blocker medications used to treat BPH.

Cataracts

Hildreth CJ, Burke AE, Glass RM. — Wed, 20 May 2009 00:00:00 GMT

Cataracts are the leading cause of blindness worldwide. They can occur at any age, but most cataracts occur in people over 40 years old and are considered an age-related eye disease. A cataract is a clouding of the lens in the eye. The lens is a transparent disc located behind the pupil (dark opening in the center of the eye) and the iris (the distinctly colored part around the pupil). The lens helps to focus light on the retina, located at the back of the eye, where nerve signals are created and transmitted to the brain to create the visual image for what is seen. The lens is made of water, proteins, and polysaccharides. As we age, some of the proteins begin to clump together and the area in the lens associated with these proteins becomes cloudy. This results in a gradual change in the lens from transparent to yellowish brown. Light passing through a lens with a cataract is not clearly focused on the retina, so images received from the brain may be blurred or brown tinged. Cataracts may progress over a number of years and do not require treatment unless they compromise vision or prevent examination or treatment for other eye disorders. The May 20, 2009, issue of JAMA includes an article about cataract surgery.