The problem of the iridal prolapse during the cataract surgery in patients administering the Tamsulosin

Introduction: Tamsulosin is alfa 1a-adrenergic antagonist administered to patients with prostatic hypertrophy. It causes the relaxation of the smooth muscles of prostate and urinary bladder and results in symptom alleviation. However, Tamsulosin side effect reflects in the atony of pupil's dilatory muscle, and accordingly, the iris during the phacoemulsification becomes folded and prolapses through the phacoemulsification incision. Moreover, there is no possibility of sufficient pupil dilatation because of the predominating effect of the pupillary m. sphincteris. In order to manage the iridal prolapse during the surgery, a special high-cohesive visco-elastic as well as multi-positioned iridal retractors are being used. Case report: This is a case report of three patients. Common to all of them was that they were all males in the advanced age, had benign prostatic hypertrophy, received Tamsulosin and underwent cataract surgery by phacoemulsification. In all three patients, adequately dilated pupils required for unobstructed performance of phacoemulsification could not be achieved by regular medicaments. In addition, in all three cases, the iris prolapsed through the incision during the surgical intervention. Upon applying the viscoelastic and deepening of the anterior ocular chamber as well as after the placement of iridal retractors in different positions, the operation was successfully brought to an end. Conclusion: In patients administering the Tamsulosin, cataract phacoemulsification is more frequently associated with complications. A special problem is a constant iridal prolapse through the incision. Unfortunately, no so far described method for managing this problem has been fully successful, what was confirmed in our case reports as well. Therefore, the operation for cataract in these patients should be carried out only by most experienced and skillful surgeons.