Tamsulosin increases cataract complications

Men who take tamsulosin (Flomax^®) within 2 weeks of cataract surgery are at higher risk of serious eye complications according to a new study. Tamsulosin is commonly used to treat symptoms of benign prostatic hyperplasia (BPH) in older men, the same demographic that commonly requires cataract surgery. Researchers from Canada reviewed the records of 3550 patients who had recent exposure (within 2 weeks) to tamsulosin and 7426 patients who had recent exposure to other α-blockers from the database of more than 96,000 men who had cataract surgery between 2002 and 2007. Adverse events were significantly more common among men with recent tamsulosin exposure (7.5% vs 2.7%), but were not associated with recent exposure to other α-blockers (7.5% vs 8.0%) or to exposure to tamsulosin more than 2 weeks prior to surgery. The number needed to harm was 255 for recent exposure to tamsulosin. Complications after cataract surgery included floppy iris syndrome, retinal detachment, loss of lens or fragments, and endophthalmitis (JAMA 2009;301:1991-1996). It is postulated that tamsulosin, a selective α-blocker, targets receptors in the bladder and iris. An accompanying editorial suggests that "the data on the risk of this complication should be reassessed to determine whether a "black box" warning should be issued to caution the ophthalmic surgeon and the general public (men in particular) of danger to the eye of taking a1-adrenergic blocking agents before cataract surgery" (JAMA 2009;301:2044-2055).