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Tamsulosin is supposed to make cataract surgery riskier. In Korean national data the complication rates were the same

0.83 percent against 0.88 percent, and an adjusted odds ratio of 0.997. The finding does not retire the warning — it is what a warning looks like once surgeons have acted on it.

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In short

In a nationwide Korean cohort of patients aged 60 or over who underwent cataract surgery between 2003 and 2015, surgical complications occurred in 0.83 percent of the tamsulosin group (71 of 8,510) against 0.88 percent of the non-tamsulosin group (375 of 42,539), with no significant difference unadjusted (OR 0.946, 95% CI 0.733 to 1.220) or after adjustment for age, income, residence and systemic and ocular comorbidities (OR 0.997, 95% CI 0.749 to 1.325) — a null result the authors attribute to surgeons knowing about the exposure and adapting technique rather than to the underlying hazard being absent.

Key takeaways

  • A nationwide Korean population-based retrospective cohort covered patients aged 60 or over undergoing cataract surgery from 2003 to 2015.
  • Complications occurred in 0.88 percent of the non-tamsulosin group (375 of 42,539) and 0.83 percent of the tamsulosin group (71 of 8,510).
  • The unadjusted odds ratio was 0.946 (95% CI 0.733 to 1.220, P = 0.669).
  • The fully adjusted odds ratio was 0.997 (95% CI 0.749 to 1.325, P = 0.981).
  • Exposure was defined as tamsulosin use within one year before surgery.
  • The authors attribute the absence of excess risk to improved surgical technique and to surgeons' awareness of tamsulosin use, not to the absence of a hazard.
  • Intraoperative floppy iris syndrome remains a described effect of alpha-1a blockade; this study measured complications, not the syndrome itself.

Men on tamsulosin are told to inform their eye surgeon before cataract surgery. The reason is intraoperative floppy iris syndrome, in which the iris behaves unpredictably during the operation because the muscle that dilates it has been blocked. The Korean national data on whether this translates into more complications are worth reading carefully, because the result is easy to quote in the wrong direction.

What was measured

Cataract surgery complications, Korean national cohort
Complication rateAdjusted OR
No tamsulosin (n = 42,539)0.88% (375)reference
Tamsulosin (n = 8,510)0.83% (71)0.997 (0.749–1.325)

Exposure was any tamsulosin use in the year before the operation. The adjustment covered age, income, residence and both systemic and ocular comorbidities — glaucoma, myopia, eye trauma, diabetic eye disease, severe cataract and macular degeneration. Neither the crude nor the adjusted comparison showed a difference, and the confidence intervals are narrow enough to exclude a large effect in either direction.

Why this is not a licence to stop mentioning it

The practical instruction is therefore unchanged, and the reason for it is now better supported rather than worse. Telling the surgeon is what produces the equal complication rate; it is not made redundant by it.

What the study also does not say

It counted surgical complications recorded in claims, not episodes of floppy iris. An operation in which the iris misbehaved, was managed with a device, and finished without a recorded complication is a success in this dataset and an incident in the operating theatre. The two questions — does the syndrome occur, and does it end badly — have different answers, and only the second one was asked here.

Nor does it address stopping the drug. Discontinuing tamsulosin shortly before surgery has been studied elsewhere with mixed results, the effect on the iris dilator can persist after the drug is withdrawn, and stopping brings back the urinary symptoms the man was taking it for. Nothing in the Korean data supports that trade, and a null complication result is an argument against making it.

Sources

  1. 1

    Kwak J, Han JY, Moon SY, Nam S, Kim JY, Tchah H, Lee H

    Relationship between tamsulosin use and surgical complications of cataract surgery in elderly patients: population-based cohort study

    Frontiers in Medicine 2022;9:882131

    doi:10.3389/fmed.2022.882131 · PMID:35665322

    https://doi.org/10.3389/fmed.2022.882131