REFERENCES1. Oetting TA, Johnson AT. Tisseel and Tutoplast cover. J Cataract

Refract Surg 2007; 33:2153

2. Oswald A-M, Joly L-M, Gury C, Disdet M, Leduc V, Kanny G.

Fatal intraoperative anaphylaxis related to aprotinin after local ap-

plication of fibrin glue [letter]. Anesthesiology 2003; 99:762–763

3. Hino M, Ishiko O, Honda KI, Yamane T, Ohta K, Takubo T,

Tatsumi N. Transmission of symptomatic parvovirus B19 infec-

tion by fibrin sealant used during surgery. Br J Haematol 2000;

108:194–195

4. Honda K, Ishiko O, Tsujimura A, Hino M, Hirai K, Itoh F, Tanaka T,

Ogita S. Neutropenia accompanying parvovirus B19 infection

after gynecologic surgery. Acta Haematol 2000; 103:186–190

5. Kawamura M, Sawafuji M, Watanabe M, Horinouchi H,

Kobayashi K. Frequency of transmission of human parvovirus

B19 infection by fibrin sealant used during thoracic surgery.

Ann Thorac Surg 2002; 73:1098–1100

6. Tournoux F, Karila-Cohen D, Hvass U, Peytavin G,

Phelippeau G, Vahanian A. Neutropenie avec fievre apres double

pontage aortocoronarien. [Neutorpenia and fever after aorto-

coronary bypasses.]. Ann Chir 2004; 129:174–176

7. Streiff MB, Ness PM. Acquired FV inhibitors: a needless iatro-

genic complication of bovine thrombin exposure. Transfusion

2002; 42:18–26

REPLY: I agree with the comments of Knox Cart-wright and Tole regarding the use of Tisseel (BaxterCorp.) andTutoplast (IOP, Inc.) to cover exposed suturematerial and share their concerns. We should have in-cluded more disclaimers in our correspondence butfaced trade-offs when pressed with space limitations.The excellent points that were raised must be includedin the decision to proceed with these products in all sit-uations, including themost commonuse in eye surgery,pterygium repair.dThomas A. Oetting, MS, MD

882 LETTERS

Awareness of IFIS among primary carephysicians

Intraoperative floppy-iris syndrome (IFIS) deservesthe attention of ophthalmologists and physicians as itoccurs in about 50% of tamsulosin patients havingcataract surgery and increases the risk for posteriorcapsule rupture and vitreous loss more than 10-fold.1

However, a recent article by Chang et al.2 shows thatexcellent surgical outcome was achieved when cata-

ERRATUMIn the March issue, the names of the coauthors of the letby Vikram Sharma, MD, MRCS(Ed), MRCOphth (J Caomitted. The coauthors are Shreyasi Sharma, MBBS, SGupta, MS, MRCOphth.

J CATARACT REFRACT SUR

ract surgeons were forewarned about tamsulosin useand precautionary measures were taken before and/or during surgery. The study highlighted the impor-tance of communicating this drug history to ophthal-mologists by the prescribing physicians.

In the United Kingdom, opticians increasinglyrefer patients for cataract surgery directly to ophthal-mologists, although general practitioners (GPs) stilldo most referrals. To assess GPs’ awareness of IRIS,we surveyed 85 GPs who regularly referred patientsfor cataract surgery at our local eye unit. The postalquestionnaire was designed to assess the basic knowl-edge about the association between tamsulosin andIFIS of primary care physicians and the mean numberof patients who were started on tamsulosin everymonth.

The response rate of 75.3% (64/85) was good, with96.8% (62/64) admitting they were not aware of theassociation. Interestingly, 79.6% (51/64) were in-volved in prescribing tamsulosin monthly (morethan 5 tamsulosin prescriptions per month).

Our survey has limitations as it examined a smallcross-section of GPs. Furthermore, as the survey hasa voluntary self-reporting nature, there may beelements of recall bias. Nonetheless, the survey dem-onstrated that the level of awareness of IFIS amongGPs is very limited.

Educating primary care physicians about IFIS incataract surgery is needed and will ensure that historyof using tamsulosin is disclosed to the surgeon beforecataract surgery, with a favorable visual outcome inthis cohort of patients.

Ahmed Sallam, FRCSLondon, United Kingdom

REFERENCES1. Chang DF, Campbell JR. Intraoperative floppy iris syndrome

associated with tamsulosin. J Cataract Refract Surg 2005;

31:664–673

2. Chang DF, Osher RH, Wang L, Koch DD. Prospective multicenter

evaluation of cataract surgery in patients taking tamsulosin

(Flomax). Ophthalmol 2007; 114:957–964

ter ‘‘Time of First Review After Phacoemulsification’’taract Refract Surg 2008; 34:343) were inadvertentlyobaran S. Sharma, Sugato Paul, FRCS, and Bhaskar

G - VOL 34, JUNE 2008