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Reddy AJ, Dang A, Dao AA, Arakji G, Cherian J, Brahmbhatt H. A Substantive Narrative Review on the Usage of Lidocaine in Cataract Surgery. Cureus 2021; 13:e19138. [PMID: 34737914 PMCID: PMC8559888 DOI: 10.7759/cureus.19138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2021] [Indexed: 11/05/2022] Open
Abstract
Cataracts are a disease that causes a gradual decrease in visual prowess and requires surgery when the symptoms progress to an abhorrent state. This disease can be treated through surgical procedures that use anesthetics, such as lidocaine. Through inhibiting sensory nerve propagation to the brain, lidocaine plays an invaluable part in reducing pain for patients that undergo cataract surgery. Current clinical practice commonly utilizes 2% lidocaine with fentanyl as a combination agent. However, recent studies have reported that concentrations higher than 1% can cause substantial alteration to corneal epithelium cells. Additionally, fentanyl is cited as an extremely addictive opioid inappropriate for continual use in cataract surgeries. In this review, the authors examine the application and concentration of lidocaine, along with the various combination agents that were reported in several studies that describe the usage of the anesthetic during cataract surgery. Within the review, it was found that most surgeons generally only use lidocaine gel on the corneal epithelium tissue of patients during cataract surgery. Perhaps this standard could change over time as it is generally known that using intracameral injections in conjunction with topical anesthesia produces better patient outcomes. The authors find that although anesthetics and surgical treatment for cataracts are generally beneficial for patients, there are still many adjustments that could be implemented to enhance patient outcomes.
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Affiliation(s)
- Akshay J Reddy
- Opthalmology, California Northstate University College of Medicine, Elk Grove, USA
| | - Allen Dang
- Anaesthesia, California Northstate University College of Medicine, Elk Grove, USA
| | - Amy A Dao
- Opthalmology, California Northstate University College of Medicine, Elk Grove, USA
| | - Gordon Arakji
- Health Sciences, California Northstate University College of Health Sciences, Rancho Cordova, USA
| | - Joshua Cherian
- Health Sciences, California Northstate University College of Health Sciences, Rancho Cordova, USA
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Pescina S, Macaluso C, Gioia GA, Padula C, Santi P, Nicoli S. Mydriatics release from solid and semi-solid ophthalmic formulations using different in vitro methods. Drug Dev Ind Pharm 2017; 43:1472-1479. [PMID: 28426341 DOI: 10.1080/03639045.2017.1318910] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The aim of the present paper was the development of semi-solid (hydrogels) and solid (film) ophthalmic formulations for the controlled release of two mydriatics: phenylephrine and tropicamide. The formulations - based on polyvinylalcohol and hyaluronic acid - were characterized, and release studies were performed with three different in vitro set-ups, i.e. Franz-type diffusion cell, vial method and inclined plane; for comparison, a solution and a commercial insert, both clinically used to induce mydriasis, were evaluated. Both gels and film allowed for a controlled release of drugs, appearing a useful alternative for mydriatics administration. However, the release kinetic was significantly influenced by the method used, highlighting the need for optimization and standardization of in vitro models for the evaluation of drug release from ophthalmic dosage forms.
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Affiliation(s)
- Silvia Pescina
- a Food and Drug Department , University of Parma , Parma , Italy
| | - Claudio Macaluso
- b Ophthalmology Department, DiMeC , University of Parma , Parma , Italy
| | | | - Cristina Padula
- a Food and Drug Department , University of Parma , Parma , Italy
| | - Patrizia Santi
- a Food and Drug Department , University of Parma , Parma , Italy
| | - Sara Nicoli
- a Food and Drug Department , University of Parma , Parma , Italy
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Moisseiev E, Loberman D, Zunz E, Kesler A, Loewenstein A, Mandelblum J. Pupil dilation using drops vs gel: a comparative study. Eye (Lond) 2015; 29:815-9. [PMID: 25857606 PMCID: PMC4469672 DOI: 10.1038/eye.2015.47] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 02/23/2015] [Indexed: 12/25/2022] Open
Abstract
Purpose To compare the efficacy in pupil dilation and degree of discomfort between topical instillation of mydriatic drops and gel. Methods The study included 60 patients with no previous ocular history of trauma and surgery. One eye was dilated with two drops (tropicamide 0.5% and phenylephrine 10%), and the other with one drop of gel (tropicamide 0.5%+phenylephrine 5%). Pupil size was measured by a Colvard pupillometer at baseline and 5, 15, 30, and 45 min following instillation. Pain upon instillation was measured by visual analog scale (VAS). Results There was no difference in pupil size at baseline. Use of the gel achieved greater mydriasis than drops (P=0.01), and was also associated with lower pain scores (P=0.003). In diabetic patients, pupil size was smaller at baseline and following instillation of drops and gel. Use of the gel achieved an even greater degree of pupil dilation in this subset of patients than drops (P=0.019). Conclusions Gel formulation achieved significantly greater pupil dilation than drops, despite a lower concentration of phenylephrine, and was also associated with significantly lower patient discomfort. This study is the first report of improved mydriatic efficacy in diabetic patients.
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Affiliation(s)
- E Moisseiev
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - D Loberman
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - E Zunz
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Kesler
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Loewenstein
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - J Mandelblum
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Ogun OA, Oliver JW, Ashaye AO, Ajayi BG. Evaluating the potentiating effect of amethocaine on tropicamide-induced mydriasis in darkly pigmented irides, using infrared pupillometry. OPHTHALMOLOGY AND EYE DISEASES 2014; 6:13-9. [PMID: 24812528 PMCID: PMC4001628 DOI: 10.4137/oed.s13991] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 02/23/2014] [Accepted: 03/03/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE To determine whether prior instillation of amethocaine would increase the rate and magnitude of tropicamide-induced pupillary dilatation in darkly pigmented irides. METHOD A total of 50 healthy Africans aged 18–40 years, with darkly pigmented irides, received a drop of amethocaine in one eye and a drop of placebo in the contralateral eye, followed by two drops of tropicamide in both eyes. Serial pupil diameters were measured using a monocular infrared video pupillometer. Rate of pupillary dilatation was compared in both eyes. Survival statistics were calculated for the time taken to reach a clinically effective dilatation, clinically effective diameter (CED) of 6.0 mm. RESULTS Mean difference in pupil diameters between amethocaine- and placebo-treated eyes was 0.30 ± 0.09 mm (P < 0.002). In all, 62% of amethocaine-treated eyes and only 46% of placebo-treated eyes reached the CED. CONCLUSION We observed a small but statistically significant potentiating effect of a drop of amethocaine on tropicamide-induced dilatation within 20 minutes.
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Affiliation(s)
- Olufunmilola A Ogun
- Department of Ophthalmology, College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - Jeffrey W Oliver
- Consulting Biomedical Engineer, Cedar Park, TX, USA. ; Senior Biomedical Engineer, Optical Radiation Branch, Bioeffects Division, Air Force Research Laboratory, Tri-Services Research Laboratory, Fort Sam Houston, Texas, USA
| | - Adeyinka O Ashaye
- Department of Ophthalmology, College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - Benedictus Gk Ajayi
- Department of Ophthalmology, College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria
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Saenz-de-Viteri M, Fernández-Robredo P, de Nova E, Bonet-Farriol E, Sabater AL, Zarranz-Ventura J, Caire J, Sádaba LM, Salinas-Alamán A, García-Layana A. Comparative study measuring the dilatory effect of a mydriatic device (Mydriasert(®)) versus topical drops. Int J Ophthalmol 2013; 6:801-4. [PMID: 24392328 PMCID: PMC3874519 DOI: 10.3980/j.issn.2222-3959.2013.06.11] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 08/29/2013] [Indexed: 11/02/2022] Open
Abstract
AIM To compare the mydriatic efficacy of an ophthalmic insert (Mydriasert, MY) versus phenylephrine and tropicamide (PT) eye drops. METHODS Two controlled, prospective, randomized, single-blind studies were performed. In the first study, a total of 80 eyes from 40 outpatient-clinic patients were analyzed. PT drops were applied to the right eye, and a MY device was inserted in the left eye for 30min. Time until maximal pupil dilation for each eye was then assessed. In the second study, 80 eyes from 80 patients undergoing cataract surgery were analyzed. Pupil dilation was achieved using either PT drops three-times for one hour prior to surgery (40 patients), or a MY device was inserted one hour prior to surgery (40 patients). RESULTS In the first study, MY achieved superior mydriasis compared to PT eye drops at 90min (9.04±1.33mm vs 8.78±1.37mm, P=0.012). However MY took longer than PT drops to achieve maximal dilation, and mydriasis was inferior in eyes with MY compared to PT drops at 30min (7.21±1.73mm vs 8.22±1.43mm, P<0.001), the two groups only becoming similar by 60min (8.85±1.44mm vs 8.71±1.27mm, P=0.236). In the second study, both MY and PT achieved similar levels of mydriasis at the beginning of surgery (8.75±0.76mm with MY vs 8.77±0.63mm with PT), and also at the end of surgery (7.96±1.06mm with MY vs 8.32±0.72mm with PT), with no significant difference between groups (P=0.08). MY was well tolerated and cardiovascular effects were not influenced by dilation method. CONCLUSION MY could be a safe and efficacious alternative for mydriasis. The mydriatic effect of MY is as good as conventional PT eye drops after 60min, and is superior after 90min. MY also maintains good pupil dilation during cataract surgery.
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Affiliation(s)
- Manuel Saenz-de-Viteri
- Department of Ophthalmology, University of Navarra, 36th Pio XII Ave, Pamplona 31008, Spain
| | | | - Elisa de Nova
- Department of Ophthalmology, University of Navarra, 36th Pio XII Ave, Pamplona 31008, Spain
| | - Elvira Bonet-Farriol
- Department of Ophthalmology, University of Navarra, 36th Pio XII Ave, Pamplona 31008, Spain
| | - Alfonso L Sabater
- Department of Ophthalmology, University of Navarra, 36th Pio XII Ave, Pamplona 31008, Spain
| | - Javier Zarranz-Ventura
- Department of Ophthalmology, University of Navarra, 36th Pio XII Ave, Pamplona 31008, Spain
| | - Josemaria Caire
- Department of Ophthalmology, University of Navarra, 36th Pio XII Ave, Pamplona 31008, Spain
| | - Luis M Sádaba
- Department of Ophthalmology, University of Navarra, 36th Pio XII Ave, Pamplona 31008, Spain
| | - Angel Salinas-Alamán
- Department of Ophthalmology, University of Navarra, 36th Pio XII Ave, Pamplona 31008, Spain
| | - Alfredo García-Layana
- Department of Ophthalmology, University of Navarra, 36th Pio XII Ave, Pamplona 31008, Spain
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Improved Pupil Dilation With Medication-Soaked Pledget Sponges. AORN J 2013; 98:131-43. [DOI: 10.1016/j.aorn.2013.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 11/14/2012] [Accepted: 06/17/2013] [Indexed: 11/23/2022]
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