How does poor pupil dilation affect recovery from cataract surgery?

January 19, 2018 8:29 AM

Someone I know is getting surgery to remove a cataract in one eye. She tells me that, because her pupil has trouble dilating, the surgery will be more complicated than usual, taking about an hour rather than 5-10 minutes. She has had trouble getting in touch with the doctor to ask questions about details and the name of her condition, so I'm finding it hard to research how unusual this is, whether recovery will be different from recovering from normal cataract removal (e.g., longer), and what to particularly watch out for during recovery. Help?

She has cataracts in both eyes, but the doctor suggested removing one at a time, so she has sight in one eye while the other heals.

I'm assuming that the unusual thing about the procedure is that they'll surgically dilate her eye, but (a) I might be wrong, and (b) even if I'm right, I am having a tough time web-searching to learn how that ought to modify usual cataract-surgery-related advice.

Thanks, all.

posted by brainwane to Health & Fitness (2 answers total)

Conceivably the doctor might think she has Intraoperative Floppy Iris Syndrome:

Intraoperative floppy iris syndrome (IFIS) is a complication that may occur during cataract extraction in certain patients. This syndrome is characterized by a flaccid iris which billows in response to ordinary intraocular fluid currents, a propensity for this floppy iris to prolapse towards the area of cataract extraction during surgery, and progressive intraoperative pupil constriction despite standard procedures to prevent this.[1]

IFIS has been associated with tamsulosin (e.g., Flomax), a medication widely prescribed for urinary symptoms associated with benign prostatic hyperplasia (BPH). Tamsulosin is a selective alpha blocker that works by relaxing the bladder and prostatic smooth muscle. As such, it also relaxes the iris dilator muscle by binding to its postsynaptic nerve endings. Even if a patient has only taken tamsulosin once in their life, that dose is enough to cause IFIS during cataract extraction indefinitely.[2][3] Various alpha-blockers are associated with IFIS, but tamsulosin has a stronger association than the others.[4]

posted by jamjam at 9:41 AM on January 19, 2018

I thought IFIS too. I had this when I had cataract surgery, because I was taking Flomax. It made my operation last longer, and my recuperation period longer, but other than that caused no problems, which I understand is by far the typical case, as long as they know in advance, which it sounds like they do. There's no point in discontinuing the Flomax and doing it later, for reasons given by jamjam. Doing the two eyes separately is standard procedure, also for the reasons given.
posted by ubiquity at 11:04 AM on January 19, 2018