<p><strong>Clinicians should counsel patients with LUTS/BPH planning for cataract surgery about the associated risks of IFIS with ABs and advise patients to discuss these risks with their ophthalmologist. (<em>Clinical Principle</em>)</strong></p>
Discussion
Discussion
<p>Updated literature continues to show an increased risk of IFIS with AB therapy. This was first described by Chang et al. in 2005 as a triad of progressive intraoperative miosis despite preoperative dilation, billowing of a flaccid iris, and iris prolapse toward the incision site during phacoemulsification for cataract surgery.<sup>156</sup> The risk persists even after discontinuation of the medication for as long as a year. This was initially described for tamsulosin, however, other ABs were also implicated along with other classes of medications and systemic risk factors. Tamsulosin continues to carry the highest risk as does terazosin and doxazosin. Alfuzosin also has some risks but to a lesser extent, and the incidence of silodosin has not been studied. Other medications that increase risk of IFIS include 5-ARIs, angiotensin receptor antagonists, benzodiazepines, antipsychotics, and antidepressants. Other risk factors include male gender, advanced age, diabetes, hypertension, and a small pupil diameter. It is imperative that patients, urologists, and ophthalmologists work to identify risk factors preoperatively and take intraoperative measures to avoid this complication during cataract surgery.<sup>157</sup> In patients with symptomatic LUTS/BPH and a cataract, it should be recommended to undergo cataract surgery before starting ABs. Alternatively, clinicians may consider using 5 mg tadalafil.</p>