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Men who have ever taken Flomax or other drugs known as alpha-blockers to treat an enlarged prostate may face some recovery problems from, of all things, cataract surgery.

The problem has prompted an alert from the three medical associations representing most of the specialties involved in eye surgery and prostate treatment: the American Academy of Ophthalmology, the American Society of Cataract and Refractive Surgery and the American Urological Association.

The organizations are urging that any cataract surgery applicant notify his doctor if he has taken Flomax (tamsulosin), Hytrin (terazosin), Cardura (doxazosin) or Uroxatral (alfuzosin) or any other drug categorized as an alpha-blocker.

Mentioning the use of these drugs will allow eye surgeons to take special precautions to reduce the risk of potential problems during surgery that could slow patients' healing and increase the risk of post-operative complications, said representatives from the medical societies. However, there is no evidence that the potential surgical complications from these drugs cause long-term damage or vision loss. And there's no reason for those with cataracts to stop the medications before having surgery, experts said. It's just that a different procedure may be called for, they added.

"You don't need to worry; you just need to inform your eye surgeon if you are currently taking, or have ever taken, Flomax or other alpha-blockers," said Dr. David F. Chang, clinical professor of ophthalmology at the University of California, San Francisco, School of Medicine.

Chang and fellow researcher Dr. John Campbell tracked 1,600 patients and found that current or prior use of Flomax -- and to a lesser extent, other alpha-blockers -- appeared to keep the muscle of the iris, (the colored part of the eye) from allowing the pupil (the opening in the iris) to stay completely open during cataract surgery with conventional eye drops. This dilation is necessary for surgeons to remove the clouded, cataract-covered lens beneath the pupil and replace it with an artificial lens.

Instead, Chang found that alpha-blocker use may cause the pupil to suddenly constrict during surgery, causing the iris to relax, a condition that Chang and Campbell termed "intraoperative floppy iris syndrome." This doesn't cause any eye disfigurement, but it can increase the risk of the surgeon tearing a portion of the eye that holds the artificial lens in place, Chang said.

"If we know that patients have ever used Flomax or the other drugs, we can use different, longer-lasting dilation eye drops or micro-hooks to keep the pupil completely dilated during surgery," Chang said. "Taking these measures, which eye surgeons normally wouldn't use, will prevent potential problems and result in an excellent prognosis. The issue is that when the pupil isn't completely dilated, surgeons just can't see what they're doing as well."

Based on the research, the medical associations jointly issued a patient advisory Aug. 22.

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