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Sukhija J, Kaur S, Kumari K, Gupta K, Gupta PC. Cataract surgery in children using intracameral mydriatic. Indian J Ophthalmol 2024; 72:1017-1020. [PMID: 38454863 DOI: 10.4103/ijo.ijo_2628_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/06/2023] [Indexed: 03/09/2024] Open
Abstract
PURPOSE To study the pupil dynamics with premixed intracameral anesthetic mydriatic combination of phenylephrine (0.31%), tropicamide (0.02%), and lidocaine (1%) in pediatric cataract surgery. METHODS Consecutive children aged ≤12 years planned for cataract surgery were recruited. A commercially available premixed combination of phenylephrine (0.31%), tropicamide (0.02%), and lidocaine (1%) was injected at the beginning of surgery without any topical/infusion drugs for mydriasis. Pupil sizes at various points of surgery were studied. RESULTS We recruited 75 patients with a mean age of 24.3 ± 33.4 months (range: 1 month-11 years). Adequate mydriasis with a single injection was achieved in 93.5% (n = 73 eyes of 70 patients) without additional pharmacotherapy or intervention. The mean pupillary diameter increased from 1.8 ± 0.79 to 6.1 ± 1.4 mm after injection (mean change of 4.2 ± 1.25 mm from baseline). The mean variability in pupillary diameter was 0.73 ± 1.3 mm. In five eyes, good dilatation was not possible even after repeat injection. CONCLUSION Fixed-dose premixed intracameral injection is effective in pupil dilatation. It alleviates the need for any topical dilators or additional intraoperative supplementation for pediatric cataract surgery.
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Affiliation(s)
- Jaspreet Sukhija
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Nuijts RMMA, Cochener-Lamard B, Szaflik JP, Mencucci R, Chiambaretta F, Behndig A. Safety of an Intracameral Fixed Combination for Mydriasis and Intraocular Anaesthesia During Cataract Surgery. Clin Ophthalmol 2024; 18:1103-1115. [PMID: 38686012 PMCID: PMC11057510 DOI: 10.2147/opth.s453257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/08/2024] [Indexed: 05/02/2024] Open
Abstract
Purpose To compare the safety of a standardized, commercially available intracameral combination of mydriatics and anesthetic (ICMA) with a reference topical mydriatic regimen for cataract surgery. Patients and Methods The safety results from two international, randomized, controlled clinical studies were combined to compare ICMA at the beginning of cataract surgery (ICMA group) to the reference topical mydriatic regimen (reference group). Data were collected on ocular and systemic adverse events, corneal and anterior chamber examination, endothelial cell density, retinal thickness and visual acuity. Analysis was performed on a pooled safety set from both studies, preoperatively and up to 1 month postoperatively. Results 342 patients received ICMA and 318 the reference topical regimen. Ocular adverse events were reported in 17.0% of patients in the ICMA group and 18.6% in the reference group. No difference was shown between groups in endothelial cell density (2208 ± 498 cells/mm2 for ICMA group versus 2241 ± 513 cells/mm2 for the reference group; p=0.547) and retinal thickness (change from baseline less than 50 µm in 94.7% versus 95.0% of patients, respectively) at 1 month postoperatively. At 1-day post-surgery, less patients in the ICMA group had moderate or severe (Grades 2 and 3) superficial punctate corneal staining (3.9% versus 7.0% for the reference group; p=0.064). Postoperatively, some ocular symptoms were also less frequently reported in the ICMA group. Best-corrected visual acuity increased in 96.0% of patients in the ICMA group and 95.8% in the reference group at 1 month. Conclusion ICMA injection at the beginning of cataract surgery was demonstrated to be safe and may also provide perioperative and postoperative advantages over the standard topical mydriatic regimen.
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Affiliation(s)
- Rudy M M A Nuijts
- University Eye Clinic, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Béatrice Cochener-Lamard
- Ophthalmology Department, CHU Morvan, University Hospital of Brest, and University of Bretagne Occidentale (UBO), Brest, France
| | - Jacek P Szaflik
- Department of Ophthalmology, Medical University of Warsaw, Warszawa, Poland
| | - Rita Mencucci
- Eye Clinic, Department of Neurosciences, Psychology, Pharmacology, and Child Health, University of Florence, Florence, Italy
| | - Frédéric Chiambaretta
- Ophthalmology Department, CHU Gabriel Montpied, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Anders Behndig
- Department of Clinical Sciences/Ophthalmology, Umea University, Umea, Sweden
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Dereń-Szumełda JK, Dorecka M, Zandecki Ł, Mrukwa-Kominek E. Effectiveness of a Standardized Combination of Intracameral Mydriatics and Anaesthetic on Mydriasis during Cataract Surgery with Coexisting Diseases. Life (Basel) 2023; 14:14. [PMID: 38276263 PMCID: PMC10817656 DOI: 10.3390/life14010014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/13/2023] [Accepted: 12/17/2023] [Indexed: 01/27/2024] Open
Abstract
PURPOSE To examine the effectiveness of a standardized combination of intracameral mydriatics and anesthetic (SCIMA) on mydriasis in patients with coexisting diseases such as diabetes mellitus (DM) and pseudoexfoliation syndrome (PXF) during phacoemulsification. METHODS Patients with cataract were included in the study if they achieved pupil dilation diameter ≥ 6.0 mm after the administration of mydriatic eyedrops (ME) during the first visit (V1). During the second visit (V2), pupil size measurements were obtained for phacoemulsification surgery with SCIMA. Effective mydriasis was defined as a pupil diameter ≥ 6.0 mm just prior to capsulorhexis without the use of additional pupil dilating agents. The measurements after ME administration during V1 and after SCIMA use during V2 were compared. RESULTS 103 patients (103 eyes) were divided into 3 groups: cataract and DM (n = 35), cataract and PXF (n = 32), and cataract without DM or PXF (n = 36). SCIMA administration allowed the achievement of effective mydriasis (≥6.0 mm) in all groups (n = 103; 100%). Mydriasis was significantly larger (p ≤ 0.001) after ME (7.3 mm) than after SCIMA (6.8 mm) administration. CONCLUSIONS Patients with cataract and such comorbidities as DM or PXF are likely to achieve effective pharmacological mydriasis during cataract phacoemulsification after SCIMA application. Mydriasis after ME is slower and larger, while SCIMA is faster.
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Affiliation(s)
| | - Mariola Dorecka
- Department of Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-514 Katowice, Poland;
| | - Łukasz Zandecki
- Collegium Medicum, Jan Kochanowski University of Kielce, Żeromskiego 5, 25-369 Kielce, Poland;
| | - Ewa Mrukwa-Kominek
- Faculty of Medical Sciences in Katowice, Medical University of Silesia, Poniatowskiego 15, 40-055 Katowice, Poland;
- Department of Ophthalmology, Kornel Gibiński University Clinical Center, Ceglana 35, 40-514 Katowice, Poland
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Ripa M, Cuffaro G, Savastano MC, Grieco G, Rizzo S, Ricci F. Efficacy of the intracamerally administered mydriatics for cataract surgery in patients with primary open-angle glaucoma. Eur J Ophthalmol 2022; 33:1380-1389. [PMID: 36579807 DOI: 10.1177/11206721221146676] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE To compare Mydrane®, mydriatic eye drops, and Mydriasert® in terms of pupil site stability, surgical time, visual field, and anterior chamber configuration modifications among patients with primary open-angle glaucoma (POAG) during cataract extraction surgery. METHODS Retrospective analysis of sixty patients with POAG and cataract who underwent elective cataract extraction. All patients underwent routine ophthalmic examinations, including automatic visual field examination, anterior chamber configuration, specular microscopy, and arterial blood pressure measurement prior to surgery, and 24 h and 30 days postoperatively. All cataract surgeries were video-recorded and all measurements were performed using a media player. Patients divided into groups 1, 2, and 3 (n = 20 in each group) received topical mydriatic eye drops, Mydriasert®, and an intracameral injection of Mydrane®, respectively, immediately after the first incision. RESULTS The mean change in pupil size from just before capsulorhexis to the end of surgery was 0.43 ± 0.09, 0.42 ± 0.08, and 0.36 ± 0.02 mm in groups 1, 2, and 3, respectively. The mean surgery duration was similar among all the groups. The baseline main cell density slightly decreased at 24 h and remained stable for 30 days postoperatively. The mean deviation and pattern standard deviation remained stable at 1 month after surgery. At 24 h after surgery, the nasal irido-corneal angle, temporal-iridocorneal angle, and anterior chamber depth increased compared with the baseline, remaining stable for 30 days after surgery. CONCLUSIONS Mydrane® produced adequate and stable mydriasis as effectively as produced by Mydriasert® and topical eye drops.
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Affiliation(s)
- Matteo Ripa
- Ophthalmology Unit, 18654"Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy.,9371Department of Ophthalmology, Catholic University "Sacro Cuore", Rome, Italy
| | - Giovanni Cuffaro
- Ophthalmology Unit, 18654"Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy.,9371Department of Ophthalmology, Catholic University "Sacro Cuore", Rome, Italy
| | - Maria Cristina Savastano
- Ophthalmology Unit, 18654"Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy.,9371Department of Ophthalmology, Catholic University "Sacro Cuore", Rome, Italy
| | - Giulia Grieco
- Ophthalmology Unit, 18654"Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy.,9371Department of Ophthalmology, Catholic University "Sacro Cuore", Rome, Italy
| | - Stanislao Rizzo
- Ophthalmology Unit, 18654"Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy.,9371Department of Ophthalmology, Catholic University "Sacro Cuore", Rome, Italy.,Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, Pisa, Italy
| | - Francesco Ricci
- Ophthalmology Unit, 18654"Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy.,9371Department of Ophthalmology, Catholic University "Sacro Cuore", Rome, Italy
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Nucci P, Lembo A, Caputo R, Dellavalle A, Serafino M, Schiavetti I, Pichi F. Efficacy and safety of intraoperative use of tropicamide 0.02%/phenylephrine0.31%/lidocaine1% intracameral combination during pediatric cataract surgery. Int Ophthalmol 2022; 43:989-995. [PMID: 36053475 DOI: 10.1007/s10792-022-02501-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 08/26/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND To demonstrate the safety and efficacy of the intracameral use of tropicamide 0.02%/phenylephrine 0.31%/lidocaine 1% in pediatric cataract surgery, a combination widely used in adult patients but still off-label in children. METHODS Design: two-center, prospective, observational study. SETTING San Giuseppe Hospital, Milan and Meyer Children's Hospital, Florence. STUDY POPULATION children from 0 to 4 years of age undergoing cataract surgery with or without intraocular IOL implantation, in the absence of clinically significant systemic conditions, history of ocular surgery, concurrent ocular medication, hypersensitivity to any of the substances and post-traumatic cataracts. During the surgery, patients received the combination drug after the primary access to the anterior chamber. Efficacy was evaluated by achieving an adequate mydriasis in order to perform capsulorhexis, while safety was assessed by recording vital signs (heart rate, blood pressure, respiratory rate, temperature) pre- and post-administration of the substance. RESULTS This study included 53 surgical procedures of 36 patients: 41 eyes were left aphakic, while 12 eyes received primary IOL implantation. The pupil size was adequate to safely perform capsulorhexis in 52 procedures of 53. The difference in pupil enlargement was significant (6.0 ± 1.14 mm, P = < 0.001). There were no notable changes in vital parameters. CONCLUSIONS The administration of intracameral tropicamide 0.02%/phenylephrine 0.31%/lidocaine 1% in pediatric cataract surgery is effective for obtaining an adequate mydriasis without any vital parameters changes throughout the procedure.
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Affiliation(s)
- Paolo Nucci
- Department of Clinical Sciences and Community Health, University Eye Clinic, San Giuseppe Hospital-Multimedica, University of Milan, Via San Vittore 12, 20123, Milan, Italy
| | - Andrea Lembo
- Department of Clinical Sciences and Community Health, University Eye Clinic, San Giuseppe Hospital-Multimedica, University of Milan, Via San Vittore 12, 20123, Milan, Italy.
| | - Roberto Caputo
- Department of Pediatric Ophthalmology, Anna Meyer Children's University Hospital, Florence, Italy
| | - Andrea Dellavalle
- Department of Clinical Sciences and Community Health, University Eye Clinic, San Giuseppe Hospital-Multimedica, University of Milan, Via San Vittore 12, 20123, Milan, Italy
| | - Massimiliano Serafino
- Department of Neuroscience, Unit of Ophthalmology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Irene Schiavetti
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Francesco Pichi
- Cleveland Clinic Abu Dhabi, Eye Institute, Abu Dhabi, United Arab Emirates
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Kaur S, Korla S, Ram J, Gupta PC, Sukhija J. Intracameral anesthetic mydriatic (ICAM) assisted pediatric cataract surgery. Eur J Ophthalmol 2021; 32:11206721211006575. [PMID: 33781116 DOI: 10.1177/11206721211006575] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess the efficacy and safety of intracameral mydriatic and anesthetic combination for pupillary dilation in pediatric cataract surgery. METHODS This prospective series included children <12 years, with visually significant unilateral or bilateral cataracts planned for cataract surgery with/without intraocular lens implantation. At the beginning of surgery, 0.025 ml of a combination of phenylephrine hydrochloride (0.31%), tropicamide (0.02%), and lidocaine hydrochloride (1%) was injected intracamerally. The efficacy of the combination was tested by achieving capsulorhexis and intraocular lens implantation without additional mydriatics. RESULTS We recruited 13 patients (16 eyes) with a mean age of 4.1 ± 3.9 years. The mean pupillary diameter changed increased from 1.92 to 5.68 mm after injection of one unit (0.025 ml) of drug (p < 0.0001). There was a strong positive correlation of the pupillary dilation with axial length (R = 0.86) and horizontal corneal diameter (R = 0.81). Seventy-five percent patients had a pupillary diameter >6 mm and surgery could be completed successfully in all cases without additional mydriatics. In all cases, pupil dilated as the surgery progressed. No adverse event to the drug was noted. CONCLUSIONS Intracameral mydriatic-anesthetic combination is an effective and safe way to obtain stable mydriasis in pediatric cataract surgery.
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Affiliation(s)
- Savleen Kaur
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shagun Korla
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jagat Ram
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Parul Chawla Gupta
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jaspreet Sukhija
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Labetoulle M, Behndig A, Tassignon MJ, Nuijts R, Mencucci R, Güell JL, Pleyer U, Szaflik J, Rosen P, Bérard A, Chiambaretta F, Cochener-Lamard B. Safety and efficacy of a standardized intracameral combination of mydriatics and anesthetic for cataract surgery in type-2 diabetic patients. BMC Ophthalmol 2020; 20:81. [PMID: 32126990 PMCID: PMC7055021 DOI: 10.1186/s12886-020-01343-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 02/14/2020] [Indexed: 01/19/2023] Open
Abstract
Background Cataract surgery in diabetics is more technically challenging due to a number of factors including poor intraoperative pupil dilation and a higher risk of vision threatening complications. This study evaluates the safety and efficacy of an intracameral combination of 2 mydriatics and 1 anesthetic (ICMA, Mydrane) for cataract surgery in patients with well-controlled type-2 diabetes. Methods Post-hoc subgroup analysis of a phase 3 randomized study, comparing ICMA to a conventional topical regimen. Data were collected from 68 centers in Europe and Algeria. Only well-controlled type-2 diabetics, free of pre-proliferative retinopathy, were included. The results for non-diabetics are also reported. The primary efficacy variable was successful capsulorhexis without additional mydriatic treatment. Postoperative safety included adverse events, endothelial cell density and vision. Results Among 591 randomized patients, 57 (9.6%) had controlled type 2 diabetes [24 (42.1%) in the ICMA Group and 33 (57.9%) in the Topical Group; intention-to-treat (ITT) set]. Among diabetics, capsulorhexis was successfully performed without additional mydriatics in 24 (96.0%; modified-ITT set) patients in the ICMA Group and 26 (89.7%) in the Topical Group. These proportions were similar in non-diabetics. No diabetic patient [1 (0.5%) non-diabetics] in the ICMA Group had a significant decrease in pupil size (≥3 mm) intraoperatively compared to 4 (16.0%; modified-ITT set) diabetics [16 (7.3%) non-diabetics] in the Topical group. Ocular AE among diabetics occurred in 2 (8.0%; Safety set) patients in the ICMA Group and 5 (16.7%) in the Topical Group. Endothelial cell density at 1 month postoperatively was similar between groups in diabetics (P = 0.627) and non-diabetics (P = 0.368). Conclusions ICMA is effective and can be safely used in patients with well-controlled diabetes, with potential advantages compared to a topical regimen including reduced systemic risk, better corneal integrity and reduced risk of ocular complications. Trial registration The trial was registered at (reference # NCT02101359) on April 2, 2014.
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Affiliation(s)
- Marc Labetoulle
- Service d'Ophtalmologie, Hôpital Bicêtre, APHP, Université Paris Sud, Le Kremlin-Bicêtre, 94275, Paris, France.
| | | | | | - Rudy Nuijts
- University Eye Clinic, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Rita Mencucci
- A.O.U. Careggi, Clinica Oculistica, Università degli Studi di Firenze, Florence, Italy
| | | | - Uwe Pleyer
- Universitäts-Augenklinik, Charité Campus Virchow-Klinik, Berlin, Germany
| | - Jacek Szaflik
- Department of Ophthalmology, Medical University of Warsaw, Warszawa, Poland
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Guell J, Behndig A, Pleyer U, Jaulerry S, Rozot P, Pisella PJ, Robert PY, Lanzl I, Pourjavan S, Aguiar C, Fernandez J, Grabner G, Mencucci R, Chiambaretta F, Labetoulle M. Systemic exposure to intracameral vs topical mydriatic agents: in cataract surgery. Clin Ophthalmol 2019; 13:811-819. [PMID: 31118559 PMCID: PMC6501990 DOI: 10.2147/opth.s189671] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective The objective of this study was to compare systemic exposure to tropicamide/phenylephrine following intracameral or topical administration before cataract surgery. Patients and methods Mydriatics exposure was calculated in patients randomized to intracameral fixed combination of mydriatics and anesthetic ([ICMA]: tropicamide 0.02%, phenylephrine 0.31%, and lidocaine 1%, N=271) or mydriatic eye drops ([EDs]: tropicamide 0.5% and phenylephrine 10%, N=283). Additional doses were permitted if required. Mydriatic plasma levels were determined by mass spectrometric HPLC in 15 patients per group before and after administration. Results Most ICMA patients (73.6%) received a single dose (200 µL) representing an exposure to tropicamide of 0.04 mg and phenylephrine of 0.62 mg. None of these patients received additional mydriatics. In the control group (three administrations), the exposure was 0.45 (11.3-fold higher than ICMA) and 10.2 (16.5-fold higher) mg. When additional ED was used in this group (9.2% of patients), it was 37.5-fold higher for tropicamide (10 drops, 1.5 mg) and 54.8-fold higher for phenylephrine (10 drops, 34 mg) than the recommended ICMA dose. Tropicamide plasma levels were not detectable at any time point in ICMA patients while it was detectable in all ED patients at 12 and 30 minutes. Phenylephrine was detectable in 14.3% of ICMA patients compared to all ED patients at least at one time point. More ED patients experienced a meaningful increase in blood pressure and/or heart rate (11.2% vs 6.0% of ICMA patients; P=0.03). Conclusion Systemic exposure to tropicamide/phenylephrine was lower and cardiovascular (CV) effects were less frequent with ICMA. This could be of particular significance in patients at CV risk.
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Affiliation(s)
- Jose Guell
- Cornea and Refractive Surgery Unit, Instituto de Microcirugía Ocular, Barcelona, Spain,
| | - Anders Behndig
- Department of Clinical Science/Ophthalmology, Umeå University Hospital, Umeå, Sweden
| | - Uwe Pleyer
- Universitäts-Augenklinik, Charité Campus Virchow-Klinik, Berlin, Germany
| | | | | | | | | | - Ines Lanzl
- Chiemsee Augen Tagesklinik, Prien, Germany
| | | | | | | | - Gunther Grabner
- Universitätsklinik Für Augenheilkunde Und Optometrie, Der Paracelsus, Austria
| | - Rita Mencucci
- AOU Careggi, Clinica Oculistica, Università Degli Studi di Firenze, Firenze, Italy
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Nuzzi R, Baratozzi V, Sole Polito M, Tridico F. Efficacy and Safety of an Intracameral Combination of Two Mydriatics and an Anesthetic for Phacoemulsification in Complicated Patients. Open Ophthalmol J 2018. [DOI: 10.2174/1874364101812010322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Advantages of intracameral mydriatics have been demonstrated in healthy patients, but safety and efficacy in complicated subjects remain to be assessed.
Objective:
The purpose of this study is to evaluate efficacy and safety of an intracameral combination of phenylephrine (0.31%), tropicamide (0.02%) and lidocaine (1%) (Mydrane®, Thea Inc.) in phacoemulsification surgery in subgroups of patients affected by different systemic and ocular diseases.
Methods:
125 patients were recruited and compared with a control group of 39 patients. Both groups have been divided according to the presence/absence of ocular or systemic diseases. In course of surgery, grade of mydriasis and ocular analgesia have been evaluated by the surgeon. During follow-up, eventual adverse events have been monitored. Also, comfort reported by patients and surgeon has been investigated.
Results:
99.2% of patients receiving the intracameral formulation achieved acceptable mydriasis (> 6 mm), maintained during capsulorhexis, phacoemulsification and IOL insertion without the need of additional mydriatics. No adverse events or sings of unsuccessful surgery were observed among treated patients.
Conclusion:
An intracameral mydriatic solution can be a safe and comfortable tool for inducing and maintaining intraoperative mydriasis and analgesia, even in complicated patients.
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Assessing the accuracy of intracameral phenylephrine preparation in cataract surgery. Eye (Lond) 2018; 32:1615-1620. [PMID: 29907787 DOI: 10.1038/s41433-018-0143-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 04/24/2018] [Accepted: 05/03/2018] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Unpreserved phenylephrine is often used as an off-licence intracameral surgical adjunct during cataract surgery to assist with pupil dilation and/or stabilise the iris in floppy iris syndrome. It can be delivered as a neat 0.2 ml bolus of either 2.5 or 10% strength, or in a range of ad-hoc dilutions. We wished to assess the accuracy of intracameral phenylephrine preparation in clinical practice. METHODS Phenylephrine 0.2 ml was analysed both neat (2.5 and 10%) and in diluted form (ratio of 1:1 and 1:3). Samples were analysed using the validated spectrophotometric method. RESULTS A total of 36 samples were analysed. The standard curve showed linearity for phenylephrine (R2 = 0.99). Wide variability was observed across all dilution groups. There was evidence of significant differences in the percentage deviations from intended results between dilutions (p < 0.001). Mean percentage deviation for 1:3 dilution was significantly greater than neat (p = 0.003) and 1:1 dilution (p = 0.001). There was no evidence of a significant difference between 1:1 and neat (p = 0.827). CONCLUSIONS Current ad-hoc dilution methods used to prepare intracameral phenylephrine are inaccurate and highly variable. Small volume 1 ml syringes should not be used for mixing or dilution of drug. Commercial intracameral phenylephrine products would address dosage concerns and could improve surgical outcomes in cases of poor pupil dilation and/or floppy iris syndrome.
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Vazquez-Ferreiro P, Carrera-Hueso FJ, Barreiro-Rodriguez L, Diaz-Rey M, Poquet-Jornet JE, Ramón-Barrios MA, Sanjuan-Cerveró R. Effectiveness of Intracameral Phenylephrine in Achieving Mydriasis and Reducing Complications During Phacoemulsification: A Systematic Review and Meta-Analysis. J Ocul Pharmacol Ther 2017; 33:735-742. [PMID: 29099656 DOI: 10.1089/jop.2017.0084] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To compare the effectiveness of intracameral phenylephrine and topical mydriatics in achieving mydriasis and protecting against complications during phacoemulsification. METHODS A systematic search of the literature comparing the mydriatic effect and surgical safety profile of intracameral phenylephrine and topical mydriatics in phacoemulsification was conducted in the Medline, Embase, Lilacs, Web of Science, Cochrane, ClinicalTrials.gov , and Teseo databases. The search targeted clinical trials, cohort studies, and case-control studies published between April 20, 2003 and August 14, 2016. Mydriatic effect was assessed by difference in means in pupil of all the patients in the studies [mean difference (MD)] and intraoperative complications were assessed by using inverse-variance weighted odds ratios (ORs), with adjustment for dose. A meta-regression analysis was also conducted, with adjustment for dose, use of epinephrine, tamsulosin use, and type of surgery and type of intraocular lens. RESULTS We found 7 articles about mydriatic effect and another 7 about complications. Intracameral phenylephrine achieved a similar mydriatic effect to topical mydriatics, with a difference of less than 10% (MD -0.74 mm, 95% CI: -1.67 to 0.18, I2 = 95.8%, P < 0.0001). The pooled OR for complications was OR 0.50, 95% CI: 0.19-1.31, I2 = 0.0%, P = 0.670, and posterior capsular rupture was the most common complication in the different studies analyzed. CONCLUSION Intracameral phenylephrine achieves a similar mydriatic effect to topical mydriatics (difference <15%) and is associated with a not-significant effect on reducing the odds of intraoperative complications.
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Affiliation(s)
- Pedro Vazquez-Ferreiro
- 1 Ophthalmologic Department, Hospital Virxen da Xunqueira , Cee, A Coruña, Spain .,2 Social Pharmacy Department, University of Granada , Granada, Spain
| | | | | | - Marta Diaz-Rey
- 1 Ophthalmologic Department, Hospital Virxen da Xunqueira , Cee, A Coruña, Spain
| | | | | | - Rafael Sanjuan-Cerveró
- 2 Social Pharmacy Department, University of Granada , Granada, Spain .,6 Traumatology Department, Hospital de Denia Marina Salud , Dénia, Alicante, Spain
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Schulz CB, Goverdhan SV, Humphry RC. An evaluation of intracameral mydriasis for routine cataract surgery. Br J Ophthalmol 2017; 102:784-789. [PMID: 28903962 DOI: 10.1136/bjophthalmol-2017-310510] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 07/30/2017] [Accepted: 08/25/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Intracameral Mydrane might facilitate a more streamlined cataract service and improve the patient experience. There is limited 'real-world' evidence of its use in a UK setting. METHODS As part of a local evaluation of cataract surgery using intracameral Mydrane (group 2; n=60), data were collected on intraoperative pupil size and postoperative visual acuity (VA), as well as the rate of mechanical pupil dilation, intraoperative floppy iris syndrome (IFIS) and complications. Preoperative and theatre turnaround time was recorded and patients completed a validated measure of satisfaction postoperatively. Data were compared with a previous cohort subjected to the existing standard regime of preoperative topical mydriatics (group 1; n=60). RESULTS Postoperative VA was comparable between groups (0.09±0.16 vs 0.08±0.15; p=0.59). Pupil size in group 2 was 7.0±1.0 mm prior to capsulorhexis and 6.5±0.29 mm after cortical aspiration, with a smaller pupil in patients on alpha-antagonists (4.7±1.1 mm; p=0.004) at this later time point. Comparing group 2 with group 1, preoperative waiting was less (87 vs 146 min; p<0.0001) and satisfaction was higher (76.0±11.2 vs 66.3±8.6; p<0.0001), although theatre turnaround time was longer (25 min vs 22 min). CONCLUSION Intracameral mydriasis was clinically effective in most patients undergoing cataract surgery and might be associated with an improved patient experience and a more streamlined preoperative flow. Mydrane represents a licensed alternative to the off-label use of other intracameral mydriatic agents, but was not judged to be a cost-effective intervention for routine use in this particular setting.
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Teoh LS, Foo SW, Mansurali VN, Ang EL, Md Noh UK, Bastion MLC. Evaluation of Corneal Endothelial Cell Loss After Uncomplicated Phacoemulsification Cataract Surgery With Intracameral Phenylephrine. Asia Pac J Ophthalmol (Phila) 2017; 6:318-325. [PMID: 28581284 DOI: 10.22608/apo.2016206] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To study the effects of intracameral phenylephrine 1.5% on corneal endothelial cell loss and morphological changes in patients who had uneventful phacoemulsification surgery. DESIGN A double-blind randomized controlled trial. METHODS This study comprised 295 patients who were randomized into the intracameral (ICM) mydriatic group or topical mydriatic group. Central corneal endothelial cell density (ECD), coefficient of variation (CV), and percentage of hexagonal cells were measured preoperatively and postoperatively at 1 week, 6 weeks, and 3 months with specular microscope. RESULTS There was no significant difference in endothelial cell density and endothelial cell loss between the topical and ICM mydriatic groups. At 3 months, the mean endothelial cell density in the ICM group was 2129.76 ± 423.53 cells/mm2 and 2100.54 ± 393.00 cells/mm2 in the topical group (P = 0.539). The endothelial cell loss was 18.60 ± 12.79% in the IC M group and 19.44 ± 11.24% in the topical group (P = 0.550). No significant difference was seen in the percentage of hexagonal cells and coefficient of variation of patients between the 2 groups. CONCLUSIONS Intracameral phenylephrine was not associated with increased risk of postoperative endothelial cell loss or morphological changes. It can be safely injected into the anterior chamber for pupil dilatation before phacoemulsification cataract surgery.
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Affiliation(s)
- Li Sar Teoh
- Department of Ophthalmology, Penang General Hospital, George Town, Malaysia
| | - Siu Wan Foo
- Department of Ophthalmology, Penang General Hospital, George Town, Malaysia
| | | | - Ee Ling Ang
- Department of Ophthalmology, Penang General Hospital, George Town, Malaysia
| | - Umi Kalthum Md Noh
- Department of Ophthalmology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Nuijts RMMA, Mencucci R, Viaud-Quentric K, Elena PP, Olmière C, Behndig A. Ocular tolerance in rabbits after intracameral administration of a fixed combination of tropicamide, phenylephrine, and lidocaine with and without rinsing. J Cataract Refract Surg 2017; 43:673-679. [PMID: 28602331 DOI: 10.1016/j.jcrs.2017.03.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 02/21/2017] [Accepted: 03/06/2017] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the safety and tolerability of a single intracameral administration of a combined mydriatic (tropicamide and phenylephrine) and anesthetic (lidocaine) formulation (Mydrane) with or without rinsing. SETTING Iris Pharma, La Gaude, France. DESIGN Experimental study. METHODS Sixty pigmented rabbits received 100 μL or 200 μL of the combination product or a placebo (sodium chloride 0.9%) by intracameral injection. For the combination product, separate groups were included with and without rinsing after administration. From day 1 day to day 7, assessments included general clinical and ocular observations, pupil diameter measurements, corneal assessments, confocal microscopy, and electroretinography (ERG). Necropsy examinations were performed at study completion at day 8. RESULTS Rapid mydriasis, stable 24 minutes after injection and returning to baseline levels by day 1, was induced in all groups that received the combination mydriatic and anesthetic drug. Rinsing had no effect. The combination product induced no adverse effects on the anterior or posterior segment of the eye (ie, no increased corneal thickness and endothelial cell loss, no abnormalities in ERG). Slitlamp examination showed slightly increased anterior chamber inflammation with rinsing in both the study group and placebo group. This observation was not confirmed by aqueous flare examination. No toxic effects of the products were found on histological evaluation. CONCLUSION The combination mydriatic and anesthetic drug administered to pigmented rabbits as a single intracameral injection at volumes of 100 μL and 200 μL was well tolerated with no ocular adverse effects and no effect on the corneal endothelium.
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Affiliation(s)
- Rudy M M A Nuijts
- From Maastricht University Medical Center Maastricht (Nuijts), Maastricht, the Netherlands; Universita degli Studi di Firenze (Mencucci), Florence, Italy; Iris Pharma (Viaud-Quentric), La Gaude, and Laboratoires Théa (Olmière), Clermont-Ferrand, France; Umeå University Hospital (Behndig), Umeå, Sweden
| | - Rita Mencucci
- From Maastricht University Medical Center Maastricht (Nuijts), Maastricht, the Netherlands; Universita degli Studi di Firenze (Mencucci), Florence, Italy; Iris Pharma (Viaud-Quentric), La Gaude, and Laboratoires Théa (Olmière), Clermont-Ferrand, France; Umeå University Hospital (Behndig), Umeå, Sweden
| | - Karen Viaud-Quentric
- From Maastricht University Medical Center Maastricht (Nuijts), Maastricht, the Netherlands; Universita degli Studi di Firenze (Mencucci), Florence, Italy; Iris Pharma (Viaud-Quentric), La Gaude, and Laboratoires Théa (Olmière), Clermont-Ferrand, France; Umeå University Hospital (Behndig), Umeå, Sweden
| | - Pierre-Paul Elena
- From Maastricht University Medical Center Maastricht (Nuijts), Maastricht, the Netherlands; Universita degli Studi di Firenze (Mencucci), Florence, Italy; Iris Pharma (Viaud-Quentric), La Gaude, and Laboratoires Théa (Olmière), Clermont-Ferrand, France; Umeå University Hospital (Behndig), Umeå, Sweden
| | - Céline Olmière
- From Maastricht University Medical Center Maastricht (Nuijts), Maastricht, the Netherlands; Universita degli Studi di Firenze (Mencucci), Florence, Italy; Iris Pharma (Viaud-Quentric), La Gaude, and Laboratoires Théa (Olmière), Clermont-Ferrand, France; Umeå University Hospital (Behndig), Umeå, Sweden.
| | - Anders Behndig
- From Maastricht University Medical Center Maastricht (Nuijts), Maastricht, the Netherlands; Universita degli Studi di Firenze (Mencucci), Florence, Italy; Iris Pharma (Viaud-Quentric), La Gaude, and Laboratoires Théa (Olmière), Clermont-Ferrand, France; Umeå University Hospital (Behndig), Umeå, Sweden
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Zhao J, Qiu Y, Tian CL, Fan TJ. The cytotoxic and pro-apoptotic effects of phenylephrine on corneal stromal cells via a mitochondrion-dependent pathway both in vitro and in vivo. ACTA ACUST UNITED AC 2016; 68:409-17. [DOI: 10.1016/j.etp.2016.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 06/09/2016] [Indexed: 12/13/2022]
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Behndig A, Korobelnik JF. Mydriatic insert and intracameral injections compared with mydriatic eyedrops in cataract surgery: controlled studies. J Cataract Refract Surg 2016; 41:1503-19. [PMID: 26287888 DOI: 10.1016/j.jcrs.2014.12.050] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 10/06/2014] [Accepted: 12/02/2014] [Indexed: 11/29/2022]
Abstract
UNLABELLED Mydriatic eyedrops are the standard method for pupil dilation in cataract surgery, but their limitations have prompted a search for alternative techniques. Two alternatives-an ophthalmic insert containing phenylephrine and tropicamide and intracameral injections of various combinations of lidocaine, cyclopentolate, and phenylephrine, with or without epinephrine in the irrigating solution-have been assessed in prospective controlled studies, including randomized controlled trials (RCTs). We reviewed the safety and efficacy of mydriatic ophthalmic inserts and intracameral mydriatic injections compared with the safety and efficacy of mydriatic eyedrops using a systematic PubMed search (1963 to 2014). We identified 9 prospective studies (7 RCTs, 637 patients) of the mydriatic ophthalmic insert and 15 prospective studies (14 RCTs, 1020 patients) of intracameral mydriatic injections; 7 of the RCTs compared intracameral mydriatic injections and mydriatic eyedrops and 7 RCTs studied the optimum intracameral mydriatic injection protocol. The latter showed that a lidocaine and phenylephrine-based solution, without irrigating epinephrine, was optimum for intracameral mydriatic injections. The mydriatic ophthalmic insert and intracameral mydriatic injections were consistently shown to be safe and as effective as mydriatic eyedrops. Each method has distinct advantages and limitations. FINANCIAL DISCLOSURE Dr. Behndig has received fees from Théa Pharma GmbH as a member of the European Team for the Prophylaxis of Infection in Cataract Surgery group. Dr. Korobelnik has received consultancy fees from Alcon Surgical, Inc.; Allergan, Inc.; Alimera, Inc.; Bayer HealthCare AG; Carl Zeiss Meditec AG; Novartis Corp.; Roche Innovatis AG; and Théa Pharma GmbH.
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Affiliation(s)
- Anders Behndig
- From the Department of Clinical Sciences/Ophthalmology (Behndig), Umeå University Hospital, Sweden, and Service d'ophtalmologie, Centre Hospitalier Universitaire de Bordeaux, Institut de Santé Publique, d'Epidémiologie et de Développement, and the Institut National de la Santé et de la Recherche Médicale U897-Epidemiologie-Biostatistique (Korobelnik), Bordeaux, France.
| | - Jean-François Korobelnik
- From the Department of Clinical Sciences/Ophthalmology (Behndig), Umeå University Hospital, Sweden, and Service d'ophtalmologie, Centre Hospitalier Universitaire de Bordeaux, Institut de Santé Publique, d'Epidémiologie et de Développement, and the Institut National de la Santé et de la Recherche Médicale U897-Epidemiologie-Biostatistique (Korobelnik), Bordeaux, France
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Gonzalez-Salinas R, Guarnieri A, Guirao Navarro MC, Saenz-de-Viteri M. Patient considerations in cataract surgery - the role of combined therapy using phenylephrine and ketorolac. Patient Prefer Adherence 2016; 10:1795-1801. [PMID: 27695298 PMCID: PMC5029911 DOI: 10.2147/ppa.s90468] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Cataract, a degradation of the optical quality of the crystalline lens, progressive and age-related, is the leading cause of treatable blindness worldwide. Cataract surgery is the most common surgical procedure performed by ophthalmologists and is the only effective treatment for cataracts. Advances in the surgical techniques and better postoperative visual outcomes have progressively changed the primary concern of cataract surgery to become a procedure refined to yield the best possible refractive results. Sufficient mydriasis during cataract removal is critical to a successful surgical outcome. Poor pupil dilation can lead to serious sight-threatening complications that significantly increase the cost of surgery and decrease patients comfort. Mydriasis is obtained using anticholinergic and sympathomimetic drugs. Phenylephrine, an α1-adrenergic receptor agonist, can efficiently dilate the pupil when administered by intracameral injection. Additionally, nonsteroidal anti-inflammatory drugs (NSAIDs) like ketorolac, which inhibit the synthesis of prostaglandins, are used to decrease intraoperative miosis, control pain and inflammation associated with cataract surgery, and to prevent the development of cystoid macular edema following surgery. Recently, a new combination of phenylephrine and ketorolac (Omidria®) has been approved by United States Food and Drug Administration for use during cataract surgery to maintain intraoperative mydriasis, prevent miosis, and reduce postoperative pain and inflammation. Clinical trials have shown that this new combination is effective, combining the positive effects of both drugs with a good safety profile and patient tolerability. Moreover, recent reports suggest that this combination is also effective in patients with high risk of poor pupil dilation. In conclusion, cataract is a global problem that significantly affects patients' quality of life. However, they can be managed with a safe and minimally invasive surgery. Advances in surgical techniques and newer pharmacological agents such as the combination of phenylephrine and ketorolac, together with better intraocular lenses, have greatly improved visual outcomes and thus patients' expectations regarding visual recovery are also increasing.
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Affiliation(s)
- Roberto Gonzalez-Salinas
- Department of Biomedical Research, Universidad Autónoma de Querétaro, Querétaro, Mexico
- Department of Research, Asociación para Evitar la Ceguera en México, Mexico City, Mexico
| | - Adriano Guarnieri
- Department of Ophthalmology, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - Manuel Saenz-de-Viteri
- Department of Ophthalmology, Clínica Universidad de Navarra, Pamplona, Spain
- Correspondence: Manuel Saenz-de-Viteri, Ave Pio XII 36, 31008 Pamplona, Navarra, Spain, Tel +34 948 948 25 54 00, Fax +34 948 296 500, Email
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Labetoulle M, Findl O, Malecaze F, Alió J, Cochener B, Lobo C, Lazreg S, Hartani D, Colin J, Tassignon MJ, Behndig A. Evaluation of the efficacy and safety of a standardised intracameral combination of mydriatics and anaesthetics for cataract surgery. Br J Ophthalmol 2015; 100:976-985. [PMID: 26531052 PMCID: PMC4941138 DOI: 10.1136/bjophthalmol-2015-307587] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 09/24/2015] [Accepted: 10/10/2015] [Indexed: 11/12/2022]
Abstract
Background/aims To compare the efficacy and safety of intracameral (IC) administration at the beginning of cataract surgery, of Mydrane, a standardised ophthalmic combination of tropicamide 0.02%, phenylephrine 0.31% and lidocaine 1%, to a standard topical regimen. Methods In this international phase III, prospective, randomised study, the selected eye of 555 patients undergoing phacoemulsification with intraocular lens (IOL) implantation received 200 μL of Mydrane (Mydrane group) just after the first incision or a topical regimen of one drop each of tropicamide 0.5% and phenylephrine 10% repeated three times (reference group). The primary efficacy variable was achievement of capsulorhexis without additional mydriatics. The non-inferiority of Mydrane to the topical regimen was tested. The main outcome measures were pupil size, patient perception of ocular discomfort and safety. Results Capsulorhexis without additional mydriatics was performed in 98.9% of patients and 94.7% in the Mydrane and reference groups, respectively. Both groups achieved adequate mydriasis (>7 mm) during capsulorhexis, phacoemulsification and IOL insertion. IOL insertion was classified as ‘routine’ in a statistically greater number of eyes in the Mydrane group compared with the reference group (p=0.047). Patients in the Mydrane group reported statistically greater comfort than the reference group before IOL insertion (p=0.034). Safety data were similar between groups. Conclusions Mydrane is an effective and safe alternative to standard eye drops for initiating and maintaining intraoperative mydriasis and analgesia. Patients who received IC Mydrane were significantly more comfortable before IOL insertion than the reference group. Surgeons found IOL insertion less technically challenging with IC Mydrane. Trial registration number NCT02101359; Results.
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Affiliation(s)
- Marc Labetoulle
- Hôpital Bicêtre, APHP, South Paris University, Ophtalmology, Le Kremlin-Bicêtre, France.,Institute for Integrative Biology of the Cell (I2BC), Département de Virologie, CNRS, Gif/Yvette, France
| | - Oliver Findl
- Vienna Institute for Research in Ocular Surgery (VIROS), Hanusch Hospital, Vienna, Austria
| | | | - Jorge Alió
- Instituto Oftalmologico de Alicante, Alicante, Spain
| | | | - Conceição Lobo
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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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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Nakasato H, Uemoto R, Isozaki M, Meguro A, Kawagoe T, Mizuki N. Trabeculotomy ab interno with internal limiting membrane forceps for open-angle glaucoma. Graefes Arch Clin Exp Ophthalmol 2014; 252:977-82. [PMID: 24668387 DOI: 10.1007/s00417-014-2616-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 02/27/2014] [Accepted: 03/10/2014] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To describe a new technique to perform trabeculotomy ab interno on eyes with open-angle glaucoma (OAG). METHODS This was a retrospective study. We inserted a 25-gauge forceps that is usually used for internal limiting membrane peeling into the anterior chamber, and grasped and pulled the inner wall of Schlemm's canal away from the canal. The inner wall of Schlemm's canal was stripped for about 100° to 120° in 26 eyes of 23 patients. The intraocular pressure (IOP) and number of glaucoma medications were recorded before, and 1 day, 1 week, 2 weeks, and 1, 3, 6, 10, 12, 15, 17, 19, 24, 27, 30, and 33 months after the surgery. The intra- and postoperative complications were recorded. RESULTS The mean ± standard deviation of the preoperative IOP was 20.0 ± 6.8 mmHg with a range from 10 to 38 mmHg (n = 26). The IOP was significantly reduced (P < 0.05; paired t-tests) at 1 week, 2 weeks, and 1, 3, 6, 10, 12, 15, 17, 24, 19, 27, 30, and 33 months after the surgery. The mean preoperative number of glaucoma medications was significantly reduced (P < 0.001; paired t-tests) at 1 week, 2 weeks, and 1, 3, 6, 10, 12, 15, 17, 19, 24, 27, 30, and 33 months after the surgery. No vision-threatening complications were found in any of the cases, but there were blood clots in the anterior chamber postoperatively in 92.3 % of the cases. CONCLUSIONS Trabeculotomy ab interno for OAG is effective but with some minor complications. A larger number of patients with longer follow-up periods are needed to determine the long-term effectiveness of this procedure.
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Affiliation(s)
- Houmei Nakasato
- Department of Ophthalmology, Odawara Municipal Hospital, Odawara, Japan
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Effect of intracameral carbachol given during cataract surgery on macular thickness. Int Ophthalmol 2012; 32:413-6. [PMID: 22576110 DOI: 10.1007/s10792-012-9579-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 04/21/2012] [Indexed: 10/28/2022]
Abstract
To evaluate the effect of intracameral carbachol on foveal thickness in patients who underwent uneventful cataract surgery. This retrospective study included two groups: the study group patients (group 1, n = 47 eyes) had uneventful cataract surgery and received only carbachol 0.01 % for miosis; the control group patients (group 2, n = 49 eyes) had uneventful cataract surgery without carbachol or any intracameral medication(s). The groups were compared for foveal thickness after cataract surgery. All phacoemulsification plus intraocular lens implantation surgeries were performed under local anesthesia via temporal clear corneal tunnel incisions. Mean values and standard deviations were calculated for preoperative and postoperative visual acuity (VA) and foveal thickness (FT) at 1 and 4 weeks. Optical coherence tomography was used for the FT measurements, with the MM6 map program. The patients in the study and control groups had a mean age of 57.78 ± 9.07 and 59.72 ± 8.96, respectively (p = 0.355). All eyes had a significant improvement in VA. In the study group, the mean FT at the visits before and 1 and 4 weeks after surgery was 216.87 ± 21.06, 228.81 ± 30.52, and 222.94 ± 29.91 μm, respectively. For the control group, the mean FT, before and 1 and 4 weeks after surgery, was 222.53 ± 17.66, 231.67 ± 23.08, and 225.41 ± 22.59 μm, respectively. Intracameral carbachol 0.01 % had no effect on foveal thickness in patients who underwent uneventful cataract surgery.
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Sallam A, El-Defrawy H, Ross A, Bashir SJ, Towler HMA. Review and update of intraoperative floppy iris syndrome. EXPERT REVIEW OF OPHTHALMOLOGY 2011. [DOI: 10.1586/eop.11.42] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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