Patients taking tamsulosin (Flomax) for male urinary symptoms within 14 days of cataract surgery are at risk for such serious post-op complications as retinal detachment, lost lens, or lens fragment and endophthalmitis, reports a study in the May 2009 issue of the Journal of the American Medical Association.

The study notes that benign prostatic hyperplasiam (BPH), which affects close to 3 out of 4 men by the age of 70, is often treated medically because of incontinence and impotence risks associated with surgical interventions. Flomax is taken by 1% to 5% of male patients presenting for cataract surgery, say the researchers. The drug improves symptoms of BPH by relaxing receptors on smooth muscle in the prostate and bladder neck, the same receptors in the iris that, when relaxed, could lead to intraoperative floppy eye syndrome, which increases the risk of post-op complications.

Researchers examined 96,128 men aged 66 or older who underwent cataract surgery between 2002 and 2007 in Ontario, Canada. Of the 3,550 patients from that group who presented for surgery with recent exposure to tamsulosin, 100 had suspected endophthalmitis after surgery, 175 had a follow-up procedure for a lost lens or lens fragment, 35 had a retinal detachment repaired and 26 underwent subsequent surgery to fix both a lost lens or lens fragment and a detached retina. There were no significant complications associated with exposure to other medications used to treat BPH.

While the researchers note that recent warnings about tamsulosin and increasing awareness of the complications it can cause may lead to discontinuing the drug prior to cataract surgery, they say their study could not confirm the efficacy of this management strategy.

"Because the combination of cataract surgery and tamsulosin exposure is relatively common patients should be properly (notified) of the risks of drug therapy," note the researchers, adding that "preoperative systems should focus on the identification of tamsulosin use by patients (so) surgeons can plan and prepare for a potentially more complicated procedure or refer to someone with more experience."

—Daniel Cook