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R.E. Bendel, M.B. Phillips; Use of Atropine Prior to Cataract Surgery to Avoid Intraoperative Floppy Iris Syndrome in Patients Taking Flomax ® . Invest. Ophthalmol. Vis. Sci. 2006;47(13):675.
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Atropine drops may be used prior to cataract surgery to minimize floppy iris syndrome in patients taking Flomax for prostatism. Intraoperative floppy iris syndrome (IFIS) is associated with unexpected iris prolapse and pupil constriction during cataract surgery, greatly increasing surgical complexity and possible complications. The association of IFIS and the use of Flomax (tamsulosin, an alpha1 blocker used to improve urinary outflow in patients with benign prostatic hypertrophy) has been well described in the last year. Two studies examining IFIS have found that greater than 90% of them are associated with the use of Flomax. Presently a prospective, multicenter study is being done on Flomax patients using one of three different intraoperative small–pupil techniques: iris hooks, pupil–expansion rings, or a Healon5 (Advanced Medical Optics, Inc., Santa Ana, CA) technique.
Two patients at Mayo Clinic Jacksonville had unexpected IFIS and did not reveal they were taking Flomax. The second eyes were already scheduled and atropine 1% was used 10 days before the second operation in an attempt to stabilize the iris.
The two MCJ patients whom had IFIS during the first surgery required the use of iris retractors in order to complete the surgery. The second eyes which were treated with atropine 1% did not require the use of iris retractors to complete the surgery. The outcomes were a best corrected vision of 20/20 in all the eyes at 4 weeks. The surgical time and expense were greater without the atropine usage preoperatively. Several patients on Flomax have been operated on using the atropine 1% BID ten days prior to surgery and none have required intraoperative modifications, and all stayed dilated to greater than 4 mm.
Preoperative use of atropine may lower surgical difficulty, save time and expense to the patient and surgeon on patients undergoing cataract surgery at risk for IFIS.
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