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T. Rutar, T. J. Kao, Y. Han, A. Naseri; Complication Rates for Resident-Performed Phacoemulsification Surgery in Patients Taking Tamsulosin. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5589.
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Tamsulosin use is associated with intraoperative floppy iris syndrome (IFIS) and with an increased risk of complications in cataract extractions performed by expert surgeons (range 0.6 to 14.9%). Although IFIS can occur even in patients who discontinue tamsulosin one month preoperatively, the timing of tamsulosin exposure and complication risk is not well understood. The aim of this study was to report the complication rate for resident-performed cataract surgeries in patients taking tamsulosin, and to study whether the timing of preoperative tamsulosin exposure affected the complication rate.
We retrospectively reviewed electronic medical records to identify 103 eyes of tamsulosin-treated patients that underwent phacoemulsification surgery by residents at a Veterans Affairs Medical Center between 1998 and 2008. We collected data on tamsulosin use from pharmacy and primary care records, and from ophthalmology and anesthesiology preoperative histories. Complication rates were compared between eyes of patients who used tamsulosin within 30 days of surgery and eyes of patients who used tamsulosin between 31 days and 3 years prior to surgery.
The total complication rate for resident-performed cataract surgery in patients who used tamsulosin anytime within 3 years of surgery was 19.4%, with a major complication rate (vitreous loss, Descemet’s detachment, reoperation within 90 days) of 2.9% and a minor complication rate (intraoperative iris prolapse, anterior capsular tear without vitreous loss, intraocular lens problem) of 16.5%. The total complication rate was higher for the 75 eyes of patients who used tamsulosin within 30 days of surgery compared to the 28 eyes of patients who discontinued tamsulosin more than 30 days prior to surgery (24.0% vs. 7.1%, p = 0.04).
Although the total complication rate for resident surgeons was higher than the range reported in the literature for expert surgeons, the rate of major complications in resident-performed cataract surgery for tamsulosin patients was low at 2.9%. We found a higher total complication rate for patients with recent as opposed to remote use of tamsulosin preoperatively. Prospective validation of this observation is necessary.
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