“If they’re poor dilators preoperatively, I will ask them if they have ever taken Flomax or any of these other medications. Sivaraman, MD, a partner at the Cincinnati Eye Institute and a clinical assistant professor of ophthalmology at the University of Cincinnati. “Knowing if your patient has any history of taking these medications is very important, obviously, but confirming this history can sometimes be very challenging, as we all know,” says Kavitha R. Up to 90 percent of men develop BPH by their 70s or 80s, 3 a fact that should significantly increase your concern when screening patients. The result can be a floppy, billowing iris accompanied by progressive miosis during cataract surgery, with the iris threatening to prolapse through the tunnel and side-port incisions.Įven years after a patient stops taking one of these medications, surgeons note, the patient remains at risk for developing the manifestations of intraoperative floppy iris syndrome. These agents bind to and inhibit type 1 alpha-adrenergic receptors and thus inhibit smooth muscle contraction, compromising the dilator muscle in the patient. Other alpha-blockers used for BPH therapy include terazosin (Hytrin), doxazosin (Cardura), alfluzosin HCL (Uroxatral) and silodosin (Rapaflo). The major uses of alpha-blockers are for treatment of hypertension and symptomatic benign prostatic hypertrophy, although the primary agent prescribed for men with BPH-tamsulosin (Flomax, Boehringer Ingelheim)-can also help women experiencing difficulty passing urine, as well as female and male patients struggling to pass large kidney stones. The most common pre-existing factor is a patient’s history of taking alpha-1 adrenergic receptor antagonists (so called alpha-blockers), which can cause intraoperative floppy iris, as first described in a 2005 study by John R. Most surgeons group risk factors of iris prolapse into two categories-pre-existing and intraoperative. In this report, surgeons with a track record of decades of experience in understanding and controlling this common complication will explain how they identify and manage risk factors, implement time-proven preventive measures and effectively respond to acute episodes in the management of iris prolapse. We need to be prepared to respond to a lot of possible challenges, some much bigger than others.” “Beyond that, there’s not a lot that you can do, per se, until you begin the surgery. Talley-Rostov, MD, a partner at Northwest Eye Surgeons in Seattle. “Just being aware of all the risk factors is the most significant precaution you can take preoperatively for patients who are predisposed to iris prolapse,” says Audrey R. Think about the many risk factors you need to consider while managing the intense complexity of a 10-to-20-minute operation on eyes that vary widely anatomically and in terms of intraoperative responses. So: Are there reliable strategies you can use to stop it from recurring? The answer is yes-but not always. H ow many times have you been confronted by an iris that either prolapses or threatens to prolapse during cataract surgery? As any surgeon will tell you, once is too often.
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