A 68-year-old man on long-term tamsulosin for benign prostatic hyperplasia is listed for phacoemulsification. Intraoperatively the iris billows and flutters, becomes progressively flaccid, and prolapses toward the incision despite normal pressure settings. What is the most appropriate preoperative strategy to reduce this risk?

• A Stop tamsulosin 24 hours before surgery
• B Identify alpha-blocker use beforehand and use intracameral phenylephrine plus viscoelastic iris support ✓
• C Proceed routinely since tamsulosin does not affect iris behaviour
• D Perform a peripheral iridectomy before starting phacoemulsification

Explanation

Tamsulosin, an alpha-1A selective blocker, causes intraoperative floppy iris syndrome characterized by iris billowing, flaccidity, and progressive pupillary constriction with prolapse. Stopping the drug briefly does not help because receptor blockade is long lasting, so the key step is identifying its use preoperatively and preparing measures such as intracameral phenylephrine, viscoelastic maintenance of the pupil, or iris hooks.

Reference: AAO BCSC Section 11: Lens and Cataract, latest ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.