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Cataract and Refractive Surgery (part 3)

Có một số loại thuốc để điều trị phì đại tuyến tiền liệt lành tính. Các loại thuốc này là thuốc chẹn alpha 1 và cải thiện dòng chảy nước tiểu bằng cách thư giãn các cơ trơn ở cổ bàng quang, bàng quang. Tamsulosin (Flomax) được ưa chuộng bởi tiết niệu bởi vì nó có tác dụng phụ hơn hệ thống hơn những người khác như doxazosin | 3.2 Surgical Management of the Small Pupil 27 Fig. 3.8 Morcher iris diaphragm Fig. 3.9 Fine mini-sphincterotomies nique devised by Fine 4 . After the chamber is filled with viscoelastic six to eight equally spaced mini-sphincterotomies are performed. The incisions are made 0.5 mm into the pupillary sphincter and then the pupil can be stretched using any of the above techniques. The small incisions will allow the sphincter to remain functional and reduce the tears in these small pupils Fig. 3.9 . Summary for the Clinician By performing these multiple small incisions the sphincter remains useful and the tears are decreased. Six to eight equally spaced mini-sphincterotomies are performed after the chamber is filled. 3.2.7 Special Circumstances Systemic Alpha 1 Blockers There are several medications available for the treatment of benign prostatic hypertrophy. These medications are alpha 1 blockers and they improve the urinary outflow by relaxing the smooth muscle in the bladder neck and the bladder. Tam-sulosin Flomax is favored by urologists because it has fewer systemic side effects than others such as doxazosin Cardura terazosin Hytrin or alfuzosin Uroxatral . Flomax has a high affinity 28 Management of the Small Pupil for Cataract Surgery 3 Fig. 3.10 Intraoperative floppy iris syndrome and specificity for the alpha 1-A receptor subtype which is the predominant receptor in the prostate and the bladder. It has been shown that the alpha 1-A receptor is in the iris dilator muscle 10 . The use of Flo-max has led to a condition called intraoperative floppy iris syndrome IFIS recently described by Chang and Campbell Fig. 3.10 2 . The syndrome involves a triad of findings. First the iris is floppy and tends to billow with the normal flow in the anterior chamber. Second the iris tends to prolapse into the phaco and side port incisions. Finally and most concerning is the tendency toward progressive pupil constriction during surgery. This combination can lead to difficult .