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Why do Flomax commercials contain a warning about Cataract Surgery?

There is a drug side effect that is adversely affecting the treatment of cataracts by making the surgery more difficult and increasing the likelihood of surgical complications. The drugs causing this problem are Flomax and other similar medications for prostate hypertrophy.

 Insertion of Malyugin Ring during cataract surgery
The Malugyin Ring is used in cataract surgery to widen the pupil in patients with Intraoperative Floppy Iris Syndrome.

 

Flomax works to relieve the symptoms of benign prostatic hypertrophy by relaxing smooth muscle. It’s an alpha-1 adrenergic antagonist, and has a particular affinity for the sub-type alpha-1A receptors. But as a side effect, it reduces the function of the radial iris dilator muscle, which is also specifically sensitive to alpha-1A adrenergic receptors.

Most of the tasks of cataract surgery are performed behind the pupil, which is the small dark opening in the center of the iris. As a rule, cataract surgery is safer with a large, dilated pupil because it improves the surgical exposure. Unfortunately, the deleterious effects related to FLOMAX and eye surgery are often irreversible. It not only reduces pupil dilation, but there is a loss of dilator tone combined with tissue atrophy of the iris, resulting in INTRAOPERATIVE FLOPPY IRIS SYNDROME, also known by the acronym of IFIS (Cataract & Refractive Surgery Today, April 2005, pp 64-68).

Until just 2007, this was an unrecognized syndrome. It was fortuitously discovered by an eye surgeon in California, David Chang, at the University of California at San Diego. Since that time, eye surgeons have had to make drastic modifications in technique to compensate for tiny pupils while at the same time preventing iris tissue from prolapsing through even the tiniest surgical incisions. The result is a longer and often more traumatic surgery, with an increased rate of complications. Other oral medications for prostate hypertrophy can have a similar effect, but because they are not specific to alpha-1A adrenergic receptors, their effect is less severe. These include HYTRIN, CARDURA AND UROXATRAL. Another medication for BPH that has a different mechanism of action is AVODART.

Male patients who are being treated for benign prostatic hypertrophy but who have not yet undergone cataract surgery may wish to discuss these issues with their urologists. Specifically, the doctor might wish to consider an alternative therapy to Flomax if other medications without specific activity against alpha-adrenergic-1A receptors are deemed safe and effective.

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