CATARACT SURGERY IN PATIENTS RECEIVING TERAZOSIN-GREATER RISK OF COMPLICATIONS THAN PREVIOUSLY THOUGHT JOHN M RAMOCKI M.D. KRESGE EYE INSTITUTE WAYNE STATE.

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Presentation transcript:

CATARACT SURGERY IN PATIENTS RECEIVING TERAZOSIN-GREATER RISK OF COMPLICATIONS THAN PREVIOUSLY THOUGHT JOHN M RAMOCKI M.D. KRESGE EYE INSTITUTE WAYNE STATE UNIVERSITY DETROIT,MICHIGAN THE AUTHOR HAS NO FINANCIAL INTEREST IN ANYTHING PRESENTED IN THIS POSTER

INTRODUCTION ALPHA1-ANTAGONISTS USED IN THE TREATMENT OF BENIGN PROSTATIC HYPERTROPHY HAVE BEEN ASSOCIATED WITH INTRAOPERATIVE FLOPPY-IRIS SYNDROME (IFIS) –MANIFESTING IN FLUTTERING AND BILLOWING OF IRIS STROMA,IRIS mPROLAPSE,AND PROGRESSIVE CONSTRICTION OF THE PUPIL DURING CATARACT SURGERY

IFIS IFIS WAS FIRST ASSOCIATED WITH FLOMAX (TAMSULOSIN) BY CHANG AND CAMPBELL BUT NOW MANY OTHER SYSTEMIC MEDICATIONS ARE ASSOCIATED WITH IFIS INCLUDING:ALFUZOSIN (UROXATRAL),DOXAZOSIN (CARDURA),TERAZOSIN (HYTRIN),PRAZOSIN (MINIPRESS),MIANSERIN,LABETALOL (TRANDATE),PHENOXYBENZAMINE, PHENTOLAMINE,CARVEDILOL (COREG),ERGOT DERIVATIVES (ERGOTAMINE,DIHYDROERGOTAMINE),AND SOME NEUROLEPTIC AGENTS (CHLORPROMAZINE,HALOPERIDOL).

IFIS AND FLOMAX THE ASSOCIATION BETWEEN IFIS AND FLOMAX(TAMSULOSIN) HAS BEEN WELL STUDIED SINCE CHANG AND CAMPBELL’S ORIGINAL ARTICLE AND IN 2005 ASCRS ISSUED A PHYSICIAN ADVISORY REGARDING THE ASSOCIATION OF TAMSULOSIN AND IFIS AND INCREASED COMPLICATION RATES. ALSO IN 2005 THE FDA REQUIRED IFIS TO BE ADDED TO THE PRECAUTIONS AND ADVERSE REACTIONS SECTIONS OF THE FLOMAX PACKAGE INSERT.

IFIS AND TERAZOSIN THE ASSOCIATION BETWEEN IFIS AND TERAZOSIN HAS BEEN LESS WELL STUDIED ALTHOUGH TERAZOSIN (HYTRIN) IS ALSO AN ALPHA1- ANTAGONIST USED IN THE TREATMENT OF BENIGN PROSTATIC HYPERTROPHY BUT IS A LESS COMMONLY PRESCRIBED MEDICATION COMPARED TO FLOMAX ( THE MOST PRESCRIBED DRUG FOR BPH) AND IS LESS HIGHLY SPECIFIC FOR THE ALPHA1A RECEPTOR AND HAS A HIGHER INCIDENCE OF POSTURAL HYPOTENSION

PURPOSE TERAZOSIN HAS BEEN NOTED TO CAUSE IFIS BUT HAS BEEN ASSOCIATED WITH ONLY A SLIGHTLY HIGHER RISK OF COMPLICATIONS FOR PATIENTS UNDERGOING CATARACT SURGERY (COMPARED TO TAMSULOSIN WHERE THE RISK IS SUBSTANTIAL). THE PURPOSE OF THIS STUDY WAS TO DETERMINE HOW MUCH RISK TERAZOSIN POSES FOR VITREOUS LOSS AND PROLONGED O.R. TIME IN PATIENTS UNDERGOING CATARACT SURGERY.

METHODS 648 MALE PATIENT CONSECUTIVE RESIDENT SUPERVISED CATARACT OPERATIONS FROM TO WERE RETROSPECTIVELY REVIEWED FOR INCIDENCE OF VITREOUS LOSS,IRIS PROLAPSE,USE OF TERAZOSIN,OR TAMSULOSIN,LENGTH OF SURGERY,AGE OF PATIENT,AND NEED FOR IRIS HOOKS.

RESULTS-TERAZOSIN CASES 125 OF THE 648 PATIENTS WERE TAKING TERAZOSIN AT THE TIME OF THEIR CATARACT SURGERY (19% PREVALENCE) WITH MEAN AGE OF 75 YEARS. 34 OF THESE 125 PATIENTS ON TERAZOSIN HAD VITREOUS LOSS DURING THEIR CATARACT SURGERY (27% INCIDENCE),7 PATIENTS HAD IRIS PROLAPSE (6% INCIDENCE),AND 3 REQUIRED IRIS HOOKS.

RESULTS-TERAZOSIN CASES AVERAGE O.R. TIME ON PATIENTS TAKING TERAZOSIN WAS 44 MINUTES IN PATIENTS HAVING NO COMPLICATIONS AND WAS PROLONGED TO 67 MINUTES WHEN VITREOUS LOSS OCCURRED.

RESULTS-TAMSULOSIN CASES 20 PATIENTS ON TAMSULOSIN HAD A 45% INCIDENCE OF VITREOUS LOSS WITH AN AVERAGE O.R. TIME OF 39 MINUTES IN UNCOMPLICATED CASES AND AN AVERAGE O.R. TIME OF 80 MINUTES IN CASES OF VITREOUS LOSS. IRIS PROLAPSE WAS NOTED IN 3 CASES AND IRIS HOOKS WERE USED IN 1 CASE.

RESULTS-CASES WITHOUT TERAZOSIN OR TAMSULOSIN 14% INCIDENCE OF VITREOUS LOSS WITH AVERAGE O.R. TIME OF 76 MINUTES IN CASES WITH VITREOUS LOSS AND AVERAGE O.R. TIME OF 44 MINUTES IN CASES WITHOUT VITREOUS LOSS.

CONCLUSIONS USING TERAZOSIN PRIOR TO CATARACT SURGERY POSED A HIGHER RISK FOR VITREOUS LOSS AND OTHER COMPLICATIONS THAN WHAT HAS PREVIOUSLY BEEN REPORTED. THE RISK OF VITREOUS LOSS WAS HIGHER THAN AMONG PATIENTS NOT ON TERAZOSIN (27% VS 14%) BUT LOWER THAN TAMSULOSIN (45%).

CONCLUSIONS SURGEON BEWARE ! THE USE OF MEDICATION FOR BPH IS ALSO INCREASING IN THE POPULATION. IN THIS STUDY THE PREVALENCE OF TERAZOSIN INCREASED OVER THE PAST 3 YEARS FROM 13% TO 18% TO 20%.

REFERENCES CHANG DF,CAMPBELL JR.INTRAOPERATIVE FLOPPY IRIS SYNDROME ASSOCIATED WITH TAMSULOSIN.J CATARACT REFRACT SURG 2005;31: SCHWINN DA,AFSHARI NA.ALPHA1-ADRENERGIC ANTAGONISTS AND FLOPPY IRIS SYNDROME:TIP OF THE ICEBERG?[EDITORIAL] OPHTHALMOLOGY 2005;112: OSHER RH.ASSOCIATION BETWEEN IFIS AND FLOMAX.J CATARACT REFRACT SURG 2006;32:547 CHANG DF,OSHER RH,ET AL.PROSPECTIVE MULTICENTER EVALUATION OF CATARACT SURGERY IN PATIENTS TAKING TAMSULOSIN (FLOMAX).OPHTHALMOLOGY 2007;114: