Cataract surgery in patients taking alpha-1 antagonists: know the risks, avoid the complications

Abstract

Background: The growing use of alpha-1 receptor antagonists in the treatment of benign prostatic hyperplasia (BPH) has created a new problem in ophthalmic surgery, the so-called intraoperative floppy iris syndrome (IFIS). This consists of a billowing iris, insufficient pupillary dilation with progressive intraoperative miosis, and protrusion of iris tissue through the tunnel and side port incision that are made for access to the anterior chamber during surgery. IFIS presents particular difficulties in cataract surgery which is carried out through the pupil with manipulations in the immediate vicinity of the iris. The complications range from poor visibility of the operative field to iris damage with the surgical instruments and to rupture of the posterior capsule, with loss of lens material into the vitreous body.

Methods: Selective literature review.

Results: Alpha-blockers have a direct effect on the alpha-receptors of the iris but also induce ultrastructural changes in the iridial stroma, leading to IFIS. The most important factor in avoiding complications of IFIS seems to be the ophthalmic surgeon's knowledge that the patient is taking an alpha-1 receptor antagonist.

Conclusion: A thorough medical history and an optimized information flow among all physicians treating the patient-the urologist, the family physician, and the ophthalmic surgeon-are essential for safe cataract surgery.

Figure 1

Full-blown IFIS: The iris seems to be ballooning and contracts at an early stage of the surgery. The tissue has an increased tendency to prolapse through the accesses. (With permission from D F Chang, MD, Los Altos, CA, USA)

Figure 2

Iris damage in a patient with pseudophakia. The stroma is damaged by the prolapse into the main incision and by an injury caused by the phaco probe (With permission from D F Chang, MD, Los Altos, CA, USA)