Tamsulosin Dilemma in Cataract Surgery-When to Stop

To study and compare iris related complications during cataract surgery by phacoemulsification in patients who were currently on Tamsulosin vs. those in whom Tamsulosin had been discontinued for 1 week and 1 month respectively.

Thirty cataract patients were divided into 3 groups of 10 patients each. One group continued on Tamsulosin while the other two groups discontinued Tamsulosin for 1 week and 1 month respectively. Iris related complications and ease of surgery were noted and compared. Pupillary diameters of the patients were measured before and after surgery.

Each patient administered tamsulosin had a sluggish hypotonic iris, along with a tendency toward miosis and a tendency for prolapse of the iris into the phaco tunnel or into the side port during cataract surgery. Sluggish irises also often adhered to the phaco tip or to the irrigation-aspiration tip. Iris related complications where more in patients on Tamsulosin than in those that had discontinued Tamsulosin. It was least in those who had discontinued the drug for a month. Preoperative and immediate postoperative pupillary diameter was smaller in the patients using tamsulosin than in those who had discontinued Tamsulosin for one week or one month.

Tamsulosin has selective α_1A-adrenoreseptor antagonistic properties and binds for a long period to the postsynaptic nerve endings of the iris dilator muscle, thus affecting iris dilatation and leading to complications in cataract surgery. Although statistically not significant (p>.05)), the number of iris related complications and eventful surgery was least in patients who had discontinued Tamsulosin for the longest duration of time.