Complicated cataract surgery in patients receiving alpha-blockers for benign prostatic hyperplasia

Of adults 50 to 80 years old, 29% of men in Europe and 34% of men in the United States have moderate to severe lower urinary tract symptoms. Alpha-blocker medications are the first line of therapy for men with these urinary symptoms. Among this population, cataracts are similarly common. The "intra-operative floppy iris syndrome" cataract surgery complication has been reported in men using alpha-blockers. OBJECTIVE To assess the frequency of cataract surgery complications arising from alpha-blocker therapy in a large patient population. DESIGN, SETTING, AND PARTICIPANTS We retrospectively reviewed the outcomes of 2666 consecutive adults who underwent elective unilateral cataract surgery. The surgeries took place between 2000 and 2005 at both a large university hospital system and a Veteran's Association medical center. Medical records were assessed for medication use, and operative records were reviewed for evidence of difficult procedures. Results The risk of complicated cataract surgery was 14.9% in patients using alpha-blockers, approximately 50% higher than those not receiving this medication (9.5%) (p=0.003). The increased rate of complicated surgeries was restricted primarily to patients over 65 years of age, as 15.6% of surgeries performed on these patients resulted in complicated surgery (p=0.03). There was no statistically significant increase in the rate of complicated surgeries in patients under age 65 who were using alpha-blockers (p>0.05). CONClUSIONS If possible, alpha blocker medications should be discontinued prior to eye surgery in older patients.