BMJ  2008;336:291 (9 February), doi:10.1136/bmj.39479.506933.3A

Letters

Benign prostatic hyperplasia

₁ adrenoreceptor antagonists and cataract surgery

The first 100% of the full text of this article appears below.

In their review on managing benign prostatic hyperplasia (BPH), Wilt and N’Dow do not mention that oral ₁ adrenoreceptor antagonists, in particular tamsulosin, can cause intraoperative floppy iris syndrome.^{1 2} The syndrome, which can persist long after the cessation of treatment, is characterised by iris flaccidity and poor pupillary dilatation, both of which can complicate cataract surgery and necessitate change in surgical technique.

Given the association of both BPH and cataract with increasing age, ophthalmologists should ask whether patients have ever received medical treatment for BPH, and referring doctors should state this fact when referring those who have. Whether stopping treatment preoperatively is beneficial is not known, but tamsulosin should not be started in those awaiting cataract surgery. In both the United Kingdom and the United States, labelling of tamsulosin has changed to include this guidance.^{3 4}

¹ Department of Ophthalmology, King’s College, London SE1 7EH

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Competing interests: None declared.

1. Wilt TJ, N’Dow J. Benign prostatic hyperplasia. Part 2—Management. BMJ 2008;336:206-10. (26 January.)[Free Full Text]
2. Chang DF, Campbell JR. Intraoperative floppy iris syndrome associated with tamsulosin. J Cataract Refract Surg 2005;31:664-73.[CrossRef][ISI][Medline]
3. MedWatch. Flomax (tamsulosin HCl). www.fda.gov/medwatch/SAFETY/2005/safety05.htm#Flomax
4. Medicines and Healthcare Products Regulatory Agency. Public assessment report—intraoperative floppy iris syndrome (IFIS) and -1 adrenoreceptor antagonist— a class effect?www.mhra.gov.uk/home/idcplg?IdcService=GET_FILE&dDocName=con2031031&RevisionSelectionMethod=Latest

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Related Article

Benign prostatic hyperplasia. Part 2—Management

Timothy J Wilt and James N’Dow
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