泌尿科摄护腺肥大用药会影响眼科白内障手术

我不再害怕开白内障手术了---客制化定位追踪微小切口白内障手术

眼科诊所中多数需要进行白内障手术的病人都是50多岁以上的中老年人，其中的男性也有一部分都有在使用泌尿科药物控制摄护腺肥大，这类药物会阻断帮助瞳孔放大的α1A，手术前若服用抑制帮助瞳孔变大的药物，手术过程中易使瞳孔越来越小，虹膜也容易从伤口鼓出，而增高手术的困难度，相对也增加风险。在手术当中，有可能伤害虹膜，而引起严重并发症。

80多岁的谢先生，五年多前在台北市某家医院进行第一次白内障手术，但是手术时因为疑似眼压高，虹膜不断鼓出，前后处理了二次，这样的经验让患者很害怕另一眼白内障的手术，以致右眼白内障这五年来越来越严重，视力仅剩0.1 (20/20），在非不得已的情况下，接受住在我们诊所附近的亲友介绍而来求诊。萧医师在手术前详细询问患者病史及用药後发现，病人有服用前列腺肥大药物（Tamsulosin），才会在施行白内障手术时，导致虹膜相对容易鼓出，增加白内障手术时的风险。萧医师注意到这个药物特有的副作用，于是在手术时特别谨慎小心处理，谢先生在最近一次回诊视力也回到我们预估的1.0(20/20)水准之上，病人开心的说：‘我的白内障问题终于顺利毕业了！我不再害怕开白内障手术了！’

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参考资料：https://www.myalcon.com/products/surgical/verion-guided-system/

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Intraoperative floppy iris syndrome associated with tamsulosin
Paul R. Brogden, Oliver C. Backhouse, and Manuel Saldana
Leeds, United Kingdom by e-mail
Author information ► Copyright and License information ►
Copyright © the College of Family Physicians of Canada

Tamsulosin, an α1-adrenergic blocking agent, is prescribed for symptoms of benign prostatic hypertrophy. In 2005 over 1.6 million prescription items of tamsulosin were dispensed in England. Intraoperative floppy iris syndrome was first described in the medical literature in April 2005, and there have been 16 subsequent related peer-reviewed publications. There is, however, no mention of the association in the current edition of the British National Formulary. Intraoperative floppy iris syndrome occurs in approximately 2% of all cataract-surgery patients and is characterized by billowing and prolapse of the iris through the corneal incisions and progressive pupillary constriction. This leads to a more complex surgery and a higher rate of complications. Many eye units now advise patients to discontinue tamsulosin for 2 weeks before cataract surgery and to start taking it again immediately after surgery, though the syndrome can occur in patients who stopped therapy 1 year before surgery. The condition is associated with all the α1-adrenergic blocking agents but is much more commonly seen with tamsulosin, which is highly selective for the α1A receptor. These particular receptors are present in bladder-neck smooth muscle and in the iris dilator muscle. Blockage of this latter muscle allows unopposed action of the parasympathetically innervated iris constrictor muscle and loss of iris tone, resulting in the clinical syndrome. Intraoperative strategies for reducing the risks during surgery have been described and include the use of iris hooks and intracameral phenylephrine.

We would like to raise awareness about this condition among primary care physicians and to advise that the use of α1-adrenergic blocking agents should be documented on referrals for cataract surgery. Such patients are at higher risk of problems both from cataract surgery and from the urologic effects of the temporary cessation of treatment.