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Tamsulosin and Complications of Cataract Surgery

Recent tamsulosin use was associated with higher risk for postoperative complications.

Tamsulosin (Flomax) is a strongly selective _1a-blocker that relaxes smooth muscle in the prostate and bladder neck. Because it also relaxes iris muscle, tamsulosin can lead to intraoperative floppy iris syndrome (IFIS) and add to the difficulty of cataract surgery. To investigate whether tamsulosin also elevates risk for adverse events after cataract surgery, Canadian investigators conducted a retrospective, population-based, case-control study using Ontario administrative data.

Of 96,000 men (age, 66) who underwent cataract surgery, 284 (0.3%) experienced one or more complications of cataract surgery within 14 days (lost lens or lens fragment, retinal detachment, or endophthalmitis). Case patients were matched to 1102 controls without complications by age, year of surgery, and surgeon. Patients with complications were significantly more likely to have used tamsulosin during the 14 days before surgery than were patients without complications (7.5% vs. 2.7%; adjusted odds ratio, 2.3). Tamsulosin use prior to the 14 days before surgery was not associated with elevated risk, nor was use of other -blockers (e.g., terazosin, doxazosin).

Comment: Because of the risks for IFIS and intraoperative complications with tamsulosin, ophthalmologists already have restricted its use before cataract surgery. This research demonstrates that risks for postoperative complications were strongest when the drug was used within 14 days before surgery. An editorialist suggests consideration of a black box warning to emphasize these risks.

— Thomas L. Schwenk, MD

Published in Journal Watch General Medicine May 28, 2009

Citation(s):

Bell CM et al. Association between tamsulosin and serious ophthalmic adverse events in older men following cataract surgery. JAMA 2009 May 20; 301:1991.

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• Medline abstract (Free)

Friedman AH. Tamsulosin and the intraoperative floppy iris syndrome. JAMA 2009 May 20; 301:2044.

• Original article (Subscription may be required)
• Medline abstract (Free)

Reader Remarks:

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• Floppy iris syndrome, TERAZOSIN
  Rupert O. Clark, MD, Retired, 20 Oct 2009 11:57 PM EST
  I am concerned that readers are allowed to continue to believe that terazosin is not associated with floppy iris syndrome.... [more]