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Some on here may remember me, I had a Turp last November (2014 )
anyway last week I had visual problems in my left eye. I was refered to an Ophthalmologist who found I had a cataract, he also found That I suffered from IFIS caused by the use of tamsulosin for my Prostitis prior to the Turp. this makes cataract surgery difficult and the recovery outcome not so good, I was not told that tamsulosin would effect the Iris of the eye and that it stays in the body for life , so please be aware of the risks before taking
tamsulosin /flomax.
I have gone private and have Cataract removal surgery on the 13th june ( Saturday next )
kind regards
Howard
3 likes, 22 replies
peter09839 howard50192
Posted
howard50192 peter09839
Posted
Intraoperative floppy iris syndrome (IFIS) is a complication observed during cataract surgery that was first described in 2005 in association with the α1-adrenergic antagonist tamsulosin.1 α1-adrenergic receptors are present in the iris dilator muscle of the eye, where inhibition of the receptors relaxes this muscle causing a floppy iris and miosis.
IFIS is characterised by a triad of intraoperative signs that may present with varying degrees of severity:
billowing of a flaccid iris stroma
progressive intraoperative pupil constriction
propensity for iris prolapse towards the phaco and side port incisions
Complications of IFIS during cataract surgery include: iris trauma; posterior capsule rupture; and vitreous loss. Postoperative complications include increased intraocular pressure and cystoid macular oedema.
kind regards
Howard
howard50192
Posted
and yes tamsulosin had effected both eyes.
kenneth1955 howard50192
Posted
howard50192 kenneth1955
Posted
howard50192
Posted
Tamsulosin-induced intraoperative floppy iris syndrome during cataract surgery
Adrian Fung, Senior Registrar, Sydney Eye Hospital; and Peter McCluskey, Director of Save Sight Institute, and Professor of Clinical Ophthalmology, Sydney Eye Hospital, SydneyAust Prescr 2010;33:88-9
Case
A 67-year-old man was referred for cataract surgery. He had noticed deteriorating vision in the left eye, greater than the right, over the last eight months with difficulty driving due to glare. He had a history of essential hypertension controlled by perindopril and had been taking tamsulosin for three years for benign prostatic hypertrophy with some symptomatic relief.
On examination, best-corrected visual acuity was 6/12 in the right and 6/24 in the left eye. Both pupils dilated minimally with topical tropicamide 1%, but light responses were normal. Apart from nuclear sclerotic cataracts, the rest of the anterior and posterior segment examination including intraocular pressures was normal.
Cataract surgery to the left eye was performed under local anaesthesia. Despite routine preoperative dilation with topical tropicamide 1%, cyclopentolate 1% and phenylephrine 2.5%, the patient's pupil remained miosed at 3 mm in diameter. This did not improve with instillation of topical phenylephrine 10%. Further intervention only increased the pupillary diameter to 3.5 mm.
The iris was noted to be atonic and had a propensity to prolapse out of the main clear corneal incision. A diagnosis of intraoperative floppy iris syndrome was suspected. Routine cataract surgery could not proceed with such a small pupil size. Four iris retracting hooks were needed to stretch the pupil to over 6 mm to enable the cataract to be removed (Fig. 1). Postoperatively, the patient's best-corrected visual acuity in his left eye improved to 6/12 on day one and 6/6 at four weeks.
Fig. 1
Iris retracting hooks used to stretch the pupil duringcataract surgery
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Comment
Intraoperative floppy iris syndrome is a condition characterised by:
poor preoperative pupil dilation
a floppy iris with a propensity to billow and prolapse from surgical wounds
progressive intraoperative miosis.
A floppy iris makes cataract surgery more difficult, with a higher incidence of complications including posterior capsular rupture, vitreous loss and iris trauma.1
Intraoperative floppy iris syndrome has most commonly been associated with tamsulosin, a selective alpha1adrenergic antagonist used for relief of lower urinary tract symptoms associated with benign prostatic hypertrophy. The syndrome is nine times more prevalent in males.2Between 40%3and 90%1of patients on tamsulosin develop intraoperative floppy iris syndrome. Tamsulosin has also been associated with a2.3 times increased postoperative cataract complication rate.3Other less selective alpha1adrenergic antagonists including terazosin and prazosin have also been implicated. Although it can occur without use of alpha1adrenergic antagonists, no statistically significant association has been found between intraoperative floppy iris syndrome and other medications or disease.2
Alpha1adrenergic antagonists relax smooth muscle, including that of the dilator muscle of the iris.3However, the mechanism by which tamsulosin induces intraoperative floppy iris syndrome is likely to be more complex given the multiple signalling pathways in the iris.2Histological studies have also failed to show changes in the dilator muscle.1Disappointingly, preoperative cessation of alpha1adrenergic antagonists does not prevent intraoperative floppy iris syndrome, even when stopped years before surgery, whereas they can induce intraoperative floppy iris syndrome within weeks of first use.1,3
The most important factor governing cataract surgery outcomes in patients on an alpha1adrenergic antagonist is recognition of its ability to induce intraoperative floppy iris syndrome. The astute surgeon can then plan a suitable management approach. Some studies have shown intraoperative cataract complication rates (posterior capsular rupture with vitreous loss) with undiagnosed intraoperative floppy iris syndrome as high as 12%,2falling to 0.6% when the surgeon is aware the patient has used tamsulosin.1
Conclusion
As cataracts and the use of alpha1adrenergic antagonists increase with age, it is not surprising that the incidence of intraoperative floppy iris syndrome has been reported to occur in up to 3.7% of cataract surgeries.2It is important that patients due for cataract surgery are told to remind their ophthalmologist if they have ever taken tamsulosin. The ophthalmologist should also seek this history. Preoperative cessation of the drug is not currently recommended. With recognition of the potential problem and careful pre-and intraoperative planning, theophthalmologist can minimise surgical complications associated with intraoperative floppy iris syndrome.
Seadaddy howard50192
Posted
Howard, Seadaddy here. I am scheduled to have laser assisted cataract surgery on 12/1/16. I was taking Tamsulosin for about 1 1/2-2 years until I discontued it 2-3 months ago. I have alerted my surgeon to this and made sure he knows he may encounter Floppy Iris Syndrome during surgery. Got some questions for you: Did your surgeon have to use rings or retractors to hold your iris open enough during surgery? Did he dilate your eyes preoperatively to test the amount of dilation before surgery? Did you have to locate a specialist experienced in floppy iris syndrome complications during cataract surgery? I'm really ticked off at my urologist for not warning me about Tamsulosin side effects when he prescribed for my BPH Nocturia.
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