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OSN SuperSite Top Story 3/22/2006

The Flomaxinators take the cataract Challenge Cup

SAN FRANCISCO — A funny and informative presentation on how to manage intraoperative floppy iris syndrome was a winner at the annual Challenge Cup session here at the American Society of Cataract and Refractive Surgery.

In the Challenge Cup, teams of outrageously dressed ophthalmologists compete to give the most amusing and informative presentations on cataract and refractive surgery. This year’s competitors in the cataract competition were the Flomaxinators vs. the Knights of See-a-Lot. The event was moderated by “referee” Roger F. Steinert, MD, and the winners were voted on by the audience.

The Flomaxinators — David F. Chang, MD; Robert H. Osher, MD; Samuel Masket, MD; I. Howard Fine, MD; and Kuldev Singh, MD — dressed in Harley Davidson jackets, modeled themselves after Arnold Schwarzenegger's character in the Terminator.

Their presentation, on “terminating” complications during cataract surgery in patients taking Flomax (tamsulosin HCl, Boehringer Ingelheim) for treatment of benign prostate hyperplasia, was the winner in the debate on cataract challenges. Voters in the audience thought the team imparted valuable practical scientific information about handling intraoperative floppy iris syndrome (IFIS) as a result of Flomax use.

The competing team, the Knights — Randall J. Olson, MD; Nick Mamalis, MD; Y. Ralph Chu, MD; and William J. Fishkind, MD — discussed complicated cataract removal in their skit-presentation.

The Flomaxinator team said surgeons can use a variety of methods to prevent or manage IFIS. Dr. Osher said ophthalmic viscosurgical devices such as Healon 5 (sodium hyaluronate, Advanced Medical Optics) can be used to prevent iris prolapse in these cases.

Dr. Fine recommended using the Morcher pupil expansion ring to manage the floppy iris. He said the ring expands the pupil and prevents iris prolapse.

“You can decenter the ring for easier removal,” he said.

Dr. Chang noted that other rings are also available that might work as well.

Dr. Singh recommended the use of iris hooks to stabilize the iris. He said the hooks are flexible, making them easy to remove, and they can be autoclaved, which helps reduce the cost of surgery.

Dr. Masket discussed the use of pharmaceutical agents, such as atropine, to prevent IFIS in patients taking Flomax.

“Use pharmaceuticals to manage the potential problems, and if that fails, use devices,” he said.

Dr. Chang described a retrospective study of 167 patients taking Flomax who had undergone cataract surgery with the use of one or more of the techniques discussed at the session. He said the series included one case with posterior capsule rupture and one with postoperative cystoid macular edema, and none of the patients had permanent pupil damage. Postoperative visual acuity was 20/40 or better in 95% of patients in the study, he said.

Dr. Masket said the take-home message for attendees was that “there are a number of ways to eliminate the problems associated with floppy iris syndrome, including hooks, expanders, OVDs or altering the fluidics.”

American Society of Cataract and Refractive Surgery 2006

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