Some medications containing alpha-1 adrenergic receptor antagonists can potentially increase the likelihood of serious complications during cataract, glaucoma or some forms of refractive surgery in susceptible patients.
RANZCO has advised the most commonly prescribed, tamsulosin (Duodart, Flomaxtra), typically used for the treatment of benign prostatic hyperplasia (BPH) in men and kidney stones in men and women, is of particular concern.
The College stated the warning has come through local ophthalmologists’ experiences, and recent studies. Most members of the American Society of Cataract and Refractive Surgery believe tamsulosin makes cataract surgery more difficult (95 per cent) and increases the risks of surgery (77 per cent).1
Intraoperative Floppy Iris Syndrome (IFIS) can be a serious side effect – permanent structural changes to the iris have been observed in patients who have taken treatment for even a short time, and also in patients years after ceasing medication.
Other related medications available in Australia and/or New Zealand with the potential to cause IFIS include alfuzosin (Xatral), terazosin (Hytrin)and doxazosin (Carduran) also used to treat BPH; prazosin (MiniPress) and labetolol (Presolol, Trandate)used to treat hypertension; and risperidone (Risperdal), ropinirole (Repreve), and mianserin (Tolvon, Lumin) used for treatment of some psychiatric conditions. A herbal preparation called saw palmetto has had similar effects.
1. Chang DF, Braga-mele R, Mamalis N, et al. Clinical experience with intraoperative floppy-iris syndrome. Results of the 2008 ASCRS member survey. J Cataract Refract Surg 2008; 34:1201-9.