Alan N. Carlson, M.D., Professor of Ophthalmology and Chief of the Corneal and Refractive Surgery Service at the Duke Eye Center routinely sees several patients each week who have been treated with Flomax prior to cataract surgery. He strongly recommends obtaining a detailed history for Flomax usage prior to performing cataract surgery. Flomax (Tamsulosin Hyrdrochloride) is an alpha receptor antagonist used primarily in male patients to relax the sphincter muscle impacted by an enlarged prostate. While the medication is helpful in treating urinary retention, it has the undesired side effect of acting on the dilator sphincter muscle of the iris pupil making pharmacologic diliation of the pupil less effect at the time of cataract surgery. This effect often persists despite discontinuation of the medication. Pupil dilation enables safer access to the cataract and removal by phacoemulsification. The patient on Flomax is often compromised by not only a small, poorly dilated pupil but also a floppy iris susceptible to even mild turbulence created by the surgical irrigating fluid. While iris hooks developed at Duke over 30 years ago and the more recently developed Malyugin Ring can be helpful, a meticulous respect for fluid dynamics, wound construction, use of a “second instrument,” and surgical patience can often accomplish successful surgery without these additional devices.
In this most recent video, Dr. Carlson demonstrates his technique emphasizing a meticulous “slow motion” technique along with a tight wound to promote a “closed system” with low turbulence and low infusion flow for successful cataract removal and insertion of a foldable IOL or intraocular lens. This particular patient however, is a middle-aged female patient who has no history of using Flomax or any alpha receptor antagonist. She was noted to dilate poorly in clinic and confirmed that she has never dilated well for eye examinations. The technique reviewed here is similar to that employed in patients taking Flomax.