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A. J. Flach; Importance of Discontinuing Preoperative Systemic Alpha-Blockers Prior to Cataract Surgery. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5429.
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To report a patient who underwent two identical phacoemulsification cataract extraction (PCE) procedures one month apart, the first surgery uncomplicated, but the second surgery complicated by inadequate intraoperative mydriasis and flash pulmonary edema (FPE). A comparison of these consecutive surgeries provides the unique opportunity to compare the identical surgeries to identify the origin of the intraoperative complications.
This retrospective, parallel case review focused upon a 66-year-old man with a history of benign prostatic hypertrophy (BPH) who underwent two separate PCE procedures one month apart, only one of which was complicated by FPE. A comparison of these surgeries is made with special attention to preoperative, intraoperative and postoperative medications and conditions in an effort to gain insight into the etiology and pathophysiology of the observed complications.
In both surgeries, the patient had poor cardiac medication adherence prior to surgery. However, preoperative use of systemic alpha-blockers to relieve the symptoms of benign prostatic hypertrophy only preceded the complicated surgery. Failure to discontinue preoperative alpha-blocker use and the resultant poor pupil dilatation was associated with an increase in operative time and additional intracameral sympathomimetic to achieve adequate intraoperative mydriasis. The relationship of these factors, and others, to the FPE will be discussed.
Although some surgeons discourage the preoperative cessation of systemic alpha-blockers because this may not prevent intraoperative floppy iris syndrome (IFIS), this surgical experience suggests that there is benefit from discontinuing alpha-blockers in an effort to simply provide better intraoperative mydriasis during PCE.
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