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Amelia C. Sheh, David A. Hollander; Role of Systemic Alpha-1 Adrenergic Receptor Antagonists On Complication Rates And Surgical Outcomes In Resident Performed Phacoemulsification Surgery. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4724.
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All patients at the Greater Los Angeles Veterans Administration (VA) Medical Center are screened prior to cataract surgery for a history of alpha-1 adrenergic receptor antagonist (a1ARA) exposure for purposes of surgical planning and proper informed consent due to correlations with intraoperative floppy iris syndrome (IFIS). This study was designed to identify the prevalence of a1ARA exposure in the male population undergoing cataract extraction and to assess the outcomes of resident-performed cataract surgery on patients with a1ARA exposure relative to age matched unexposed controls.
The electronic medical and surgical records of 639 consecutive eyes of male patients 50 years or older (mean 70.3 ± 10.3 years) undergoing phacoemulsification cataract surgery by ophthalmology residents at the Greater Los Angeles VA Hospital between January 1, 2006 and December 31, 2007 were reviewed. Collected data included patient demographics, ocular comorbidities, cataract grade, pre and postoperative best corrected visual acuity, history of a1ARA exposure, usage of specialized intraoperative pharmacologic agents/equipment, signs of IFIS, and presence of intraoperative complications.
The prevalence of a1ARA exposure was 26.3% (terazosin 15.0%, tamsulosin 9.4%). The prevalence of IFIS in patients with a1ARA exposure (22.6%) was significantly higher than in those without prior exposure (1.7%) (p < 0.001). The mean preoperative visual acuity in all patients was 20/89 (mean ± SD logMAR 0.65 ± 0.50). There was no difference in mean postoperative visual acuity in patients with (20/32; mean ± SD logMAR 0.20 ± 0.02) and without a1ARA exposure (20/31; mean ± SD logMAR 0.19 ± 0.01) (p = 0.331). There was no significant difference in major intraoperative complication rates (vitreous loss, retained lens fragment, suprachoroidal hemorrhage, or corneal wound burn) between patients with (3.0%) and without (2.8%) a1ARA exposure (p = 0.88).
In the setting of a VA Hospital, over one quarter of male patients over the age of 50 years have been treated with systemic a1ARAs, and over 20% of these patients demonstrate signs of IFIS. Careful preoperative screening for a1ARA usage allows the resident surgeon to anticipate IFIS and employ pharmacologic and surgical interventions, such as intracameral epinephrine, meticulous wound construction, and/or placement of iris hooks or Malyugin rings, to reduce the risk of intraoperative complications.
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