Evolution in the Risk of Cataract Surgical Complications among Patients Exposed to Tamsulosin

Abstract

Purpose: Tamsulosin is associated with intraoperative floppy iris syndrome (IFIS), an important risk factor for complications during cataract surgery. Significant efforts have been made to increase awareness of the risks associated with tamsulosin, and educational initiatives have fostered the uptake of technical adjustments to decrease adverse event rates among tamsulosin-exposed patients. However, the effectiveness of these efforts at the population level has not been studied.Design: Population-based study to evaluate cataract surgical adverse event rates over time among patients exposed to tamsulosin and those not exposed to this drug.Participants: All male patients 66 years of age and older undergoing cataract surgery in Ontario, Canada, between January 1, 2003, and December 31, 2013, were included in the study.Methods: Linked healthcare databases were used to study the evolution in the risk of cataract surgical adverse events over time among tamsulosin-exposed and nonetamsulosin-exposed patients adjusting for patient-, surgeon-, and institution-level covariates. The study timeframe incorporated periods before and after the first reports of tamsulosin-associated IFIS.Main Outcome Measures: Four important cataract surgical adverse events were evaluated: posterior capsule rupture, dropped lens fragments, retinal detachment, and suspected endophthalmitis.Results: Among patients exposed to tamsulosin, the risk of surgical adverse events decreased over time (odds ratio, 0.95 per year; 95% confidence interval, 0.91e0.99 per year). This trend was observed across patient age strata. Among patients not recently exposed to tamsulosin, the risk of surgical adverse events also decreased over time (odds ratio, 0.96 per year; 95% confidence interval, 0.95e0.98 per year).Conclusions: The risk of cataract surgical complications among both tamsulosin-exposed and nonetamsulosin-exposed patients declined between 2003 and 2013. Tamsulosin remains an important risk factor for cataract surgical adverse events, and ongoing efforts will be needed to develop and disseminate surgical approaches that mitigate the risks posed by tamsulosin.

The Making of a Great Surgeon

“…Notably, some previous studies have shown continued marginal improvements to higher volumes than seen in this study. 1,[8][9][10][11] Past experience, as evaluated by total career surgical volume and years of practice, was not found to be predictive of most outcomes in the study. This somewhat paradoxical finding may be the result of the correlations among these variables, notwithstanding the tolerance values reported.…”

“…In particular, Cox et al 7 have provided new insight into the effect of surgeon volume on visual acuity outcomes, supporting previous research that has focused on complication rates. 1,[8][9][10][11] Although increasing surgical volume correlated with better visual acuity outcomes, Cox et al 7 were careful to point out that the observed effects were modest and that the clinical significance is important to consider. The study also showed that beyond a relatively modest number of cases (350/year), higher volumes of surgery did not lead to further improvements in visual acuity outcomes.…”

Urology Residency Directors' Awareness of Association between α-Adrenergic Antagonists and Floppy Iris Syndrome and Practice Patterns Regarding Prophylactic α-Adrenergic Antagonists

“…2,19,20 Of note, a recent study of over 400,000 cataract operations from 2003 to 2013 showed that the rate of adverse events associated with cataract surgery in general, and the rate of adverse events associated with IFIS specifically, have decreased over time in part due to safer, adaptive techniques to combat IFIS such as viscosurgical devices, mechanical pupil expansion devices, and intensive pharmacologic pupil dilation. 3,21 Considering the decrease in the IFIS-associated complication rate, as well as the benefits of α blockers with respect to postoperative recovery, the risk-benefit ratio of prophylactic α antagonist usage warrants further exploration.…”

“…This paucity of patient counseling makes it less likely for cataract surgeons to be informed of patients' perioperative α blocker usage, potentially leading to less use of the adaptive techniques for IFIS which have lowered adverse events to 1.0% of surgeries for tamsulosin users. 3,21 Study limitations include the 50% response rate and the fact that our sample population included only urology residency PDs. Despite having a wide geographic distribution, our survey respondents may not be representative of the more general urologist population in America, especially regarding their knowledge about IFIS.…”

<p>Intraoperative Floppy Iris Syndrome: Updated Perspectives</p>

“…9 In addition, Campbell et al, in a recent study, descripted that the rates of complications associated with IFIS in their centre, steadily decrease year by year due to the increased awareness for IFIS. 69 The long-term consequences of a cataract surgery complicated with IFIS include permanent pupil deformity and vision loss secondary to endophthalmitis, macular edema or retinal detachment. 55…”