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Chua MJ, Varshney N, Eke T. Intracameral phenylephrine for surgical mydriasis and intraoperative floppy-iris syndrome: systemic adverse effects and optimal dose. J Cataract Refract Surg 2024; 50:187-194. [PMID: 37748029 PMCID: PMC10805356 DOI: 10.1097/j.jcrs.0000000000001319] [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: 07/30/2023] [Revised: 09/08/2023] [Accepted: 09/13/2023] [Indexed: 09/27/2023]
Abstract
Phenylephrine, a potent sympathomimetic, induces mydriasis via iris dilator muscle contraction. Intracameral (IC) phenylephrine has been successfully used in cataract surgery for initial mydriasis, maintaining mydriasis, and management of intraoperative floppy-iris syndrome. Serious systemic adverse events (mainly cardiovascular) have been described with topical phenylephrine drops, but we found very little evidence of such adverse events associated with IC phenylephrine use. However, we suspect under-reporting of such adverse events, as they may instead be ascribed to anxiety, positioning, anesthesia, etc. Optimal dosage/concentrations for IC phenylephrine use in different purposes have not been fully studied. In the absence of robust evidence, we suggest that lower but effective IC phenylephrine concentrations are used: a lower concentration (0.31%), in conjunction with an anticholinergic and lidocaine, may be used for initial mydriasis. For management of intraoperative floppy-iris syndrome, 0.31% may be effective, though a higher concentration (1% to 1.25%) may be required.
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Affiliation(s)
- Matthew J. Chua
- From the Department of Anaesthesia, Liverpool Hospital, Liverpool, Australia (Chua); East Kent Hospitals University NHS Foundation Trust, Canterbury, United Kingdom (Varshney); Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, United Kingdom (Eke)
| | - Natasha Varshney
- From the Department of Anaesthesia, Liverpool Hospital, Liverpool, Australia (Chua); East Kent Hospitals University NHS Foundation Trust, Canterbury, United Kingdom (Varshney); Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, United Kingdom (Eke)
| | - Tom Eke
- From the Department of Anaesthesia, Liverpool Hospital, Liverpool, Australia (Chua); East Kent Hospitals University NHS Foundation Trust, Canterbury, United Kingdom (Varshney); Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, United Kingdom (Eke)
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Ezepue CO, Anyatonwu OP, Duru CC, Odini F, Nwachukwu NZ, Onoh C, Nwachukwu N, Oguonu CA. Effects of music on the preoperative and intraoperative anxiety through the assessment of pupil size and vital signs (blood pressure, respiratory, and pulse rates) among cataract surgery patients at UNTH-Enugu. FRONTIERS IN OPHTHALMOLOGY 2024; 3:1340752. [PMID: 38983030 PMCID: PMC11182256 DOI: 10.3389/fopht.2023.1340752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 12/14/2023] [Indexed: 07/11/2024]
Abstract
Background/Aim To examine how music can impact preoperative and intraoperative anxiety via assessment of physiological markers such as pupil size, blood pressure, pulse rate, and respiratory rate. Methods This is a randomized interventional study of individuals aged 50 years and above who were scheduled for and undergoing cataract surgery under regional anesthesia, with music (test group) randomly matched with similar individuals undergoing the same procedure but without music (control group). The surgeries were performed in the operating theater of the Department of Ophthalmology, University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu. Using a systematic random sampling method, a total of 98 patients were grouped into two. Both groups completed the State-Trait Anxiety Inventory (STAI) questionnaire at baseline, immediately upon entrance into the preoperative room and 5 min after intervention. Relevant study indices (blood pressure, pulse, respiratory rate, and pupil diameter) were measured and recorded, and these served as baseline parameters. The STAI questionnaire was then administered. Results were analyzed using the SPSS version 20 and analysis of variance was used to compare means of variables measured at baseline, preoperative before intervention, and preoperative after intervention. Categorical variables were compared using the Chi-square test. Student's t-test was used to analyze the continuous variables. Results Our analysis, using the multiple linear regression, showed that music has an effect on preoperative anxiety and intraoperative anxiety by positively affecting the blood pressure, pulse rate, respiratory rate, and pupil diameter (P ≤ 0.001). Conclusion Music reduces preoperative and intraoperative anxiety evidenced by its effect on the physiological biomarkers.
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Affiliation(s)
| | - Obinna Princewill Anyatonwu
- Department of Optometry, Faculty of Medicine and Health Sciences, Abia University Uturu, Okigwe, Abia, Nigeria
| | - Christian Chukwuka Duru
- Department of Optometry, Faculty of Medicine and Health Sciences, Imo State University, Owerri, Nigeria
| | - Franklin Odini
- Department of Community Medicine, Federal Medical Centre Umuahia, Umuahia, Abia, Nigeria
| | - Nkiru Zuada Nwachukwu
- Department of Ophthalmology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Chidimma Onoh
- Department of Psychiatry, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Nwamaka Nwachukwu
- Department of Ophthalmology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Chukwunonso Afam Oguonu
- Department of Ophthalmology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
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Xie W, Yu Q, Wang L, Shao Y, Bo Q, Wu G. Toll-like receptor 3 gene regulates cataract-related mechanisms via the Jagged-1/Notch signaling pathway. Bioengineered 2022; 13:14357-14367. [PMID: 35758265 PMCID: PMC9342145 DOI: 10.1080/21655979.2022.2085391] [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] [Indexed: 11/13/2022] Open
Abstract
Epithelial-melancholy transition (EMT) is the main cause of organ fibrosis and a common pathogenetic mechanism in most cataracts. This study aimed to explore the molecular mechanism of Toll-like receptor (TLR)-3 in the occurrence and development of post-cataract EMT and to provide new ideas for the prevention and treatment of posterior capsule opacification (PCO). In the presence or absence of TLR3, the human lens epithelial cell (LEC) line, SRA01/04, was treated with the transforming growth factor (TGF)-β2. Cell counting kit-8 (CCK-8) and Transwell assays were used to analyze the cell proliferation, migration, and invasion. The expression levels of proteins and RNAs were detected by western blotting and quantitative polymerase chain reaction (qPCR) experiments. Functional gain and loss studies showed that TLR3 regulates the proliferation, migration, and invasion of LECs and EMT induced by TGF-β2. Moreover, TLR3 regulates the expression of Jagged-1, Notch-1, and Notch-3 These findings indicate that TLR3 prevents the progression of lens fibrosis by targeting the Jagged-1/Notch signaling pathway to regulate the proliferation, migration, and invasion of LECs, and TGF-β2-induced EMT. Therefore, the TLR3-Jagged-1/Notch signaling axis may be a potential therapeutic target for the treatment of fibrotic cataracts.
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Affiliation(s)
- Weiwei Xie
- Department of Ophthalmology, The Affiliated Ningbo Eye Hospital of Wenzhou Medical University, Ningbo, Zhejiang, China
| | - Qihua Yu
- Department of Ophthalmology, The Affiliated Ningbo Eye Hospital of Wenzhou Medical University, Ningbo, Zhejiang, China
| | - Layi Wang
- Department of Ophthalmology, The Affiliated Ningbo Eye Hospital of Wenzhou Medical University, Ningbo, Zhejiang, China
| | - Yongqing Shao
- Department of Ophthalmology, The Affiliated Ningbo Eye Hospital of Wenzhou Medical University, Ningbo, Zhejiang, China
| | - Qingyun Bo
- Department of Ophthalmology, The Affiliated Ningbo Eye Hospital of Wenzhou Medical University, Ningbo, Zhejiang, China
| | - Guohai Wu
- Department of Ophthalmology, The Affiliated Ningbo Eye Hospital of Wenzhou Medical University, Ningbo, Zhejiang, China
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Park SSE, Wilkinson S, Mamalis N. Dealing with floppy iris syndrome. Curr Opin Ophthalmol 2022; 33:3-8. [PMID: 34711714 DOI: 10.1097/icu.0000000000000815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The aim of this study was to review and summarize recent findings and advancements regarding intraoperative floppy iris syndrome (IFIS). Although many improvements have been made for the management of IFIS, it remains a challenging condition for surgeons. An understanding of the syndrome as well as the multitude of tools to mitigate risk of complication is important for surgeons operating on high-risk patients. RECENT FINDINGS A variety of management approaches have been modified and improved or further supported with new data, such as intracameral compounds, intraoperative devices and surgical techniques. SUMMARY An understanding of risk factors is important for the identification of at-risk patients. A variety of approaches can greatly reduce incidence of IFIS complications. Multiple management strategies should be utilized to further reduce risk during these difficult surgeries.
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Affiliation(s)
- Sally S E Park
- John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
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Preoperative atropine and non-steroidal anti-inflammatory drugs for the prevention of intraoperative floppy iris syndrome. Graefes Arch Clin Exp Ophthalmol 2021; 260:893-900. [PMID: 34652535 DOI: 10.1007/s00417-021-05444-1] [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: 05/29/2021] [Revised: 09/29/2021] [Accepted: 10/01/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To examine the efficacy of preoperative administration of topical atropine 1% and non-steroidal anti-inflammatory drugs (NSAIDs) for prevention of intraoperative floppy iris syndrome (IFIS). METHODS In this retrospective cohort study, patients who underwent cataract surgery by phacoemulsification between July 2019 and February 2020 in two hospitals were included. Both hospitals are located in central Israel, have similar patient demographics and employ similar surgical techniques. They, however, differ in policy of IFIS prevention. In Meir Medical Center no preventive medications are given pre-operatively, while in Shamir Medical Center patients at-risk for IFIS receive topical atropine 1% once daily and non-steroidal anti-inflammatory drugs (NSAIDs) thrice daily for 3 days preoperatively. RESULTS Overall, 207 eyes of 207 patients with history of alpha-antagonist use were included. Mean age was 74.9 ± 7.8 years and 82.1% (n = 170) were male. Among patients from the pretreating center 86.8% (n = 92/106) were pre-treated with either NSAIDs or atropine preoperatively, while in the non-pretreating center no treatment was prescribed (n = 0/101). IFIS rate among the non-pretreating center was 29.7% (n = 30/101) compared to 15.1% (n = 16/106) in the pretreating center (p = 0.012). When strictly comparing treated to untreated patients, the treated group had an IFIS rate of 12.0% compared to 30.4% among untreated (p = 0.001). Adjusted for age and gender results remain consistent (odds ratio 0.329 for treated patients, 95% confidence interval: 0.150-0.720; p = 0.005). CONCLUSIONS IFIS rates were significantly lower in the pretreating center compared to the non-pretreating center. When comparing strictly treated to untreated patients, differences were even more pronounced.
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Intraoperative floppy iris syndrome: an updated review of literature. Int Ophthalmol 2021; 41:3539-3546. [PMID: 34184151 DOI: 10.1007/s10792-021-01936-5] [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: 08/14/2020] [Accepted: 06/18/2021] [Indexed: 10/21/2022]
Abstract
Intraoperative Floppy iris syndrome(IFIS) remains a challenge for surgeons during phacoemulsification. Initially, it was related to the use of tamsulosin, an alpha adrenergic receptor blocker used in benign prostatic hyperplasia. Subsequently, other alpha adrenergic receptor such as alfuzosin, terazosin and doxazosin alongwith different other class of medications and systemic risk factors were identified. Other class of medications includes 5-alpha reductase inhibitor, angiotensin receptor antagonist, benzodiazepines, antipsychotics and antidepressants. Other risk factors include increasing age, male gender, diabetes, hypertension and decreased preoperative pupil diameter. It is very important for surgeons to identify these risk factors preoperatively and take appropriate preoperative and intraoperative measures to tackle the dreaded complications of IFIS. Sometimes, it is important for an ophthalmologist to work in cooperation with physician and urologist to minimize the complications. In conclusion, awareness of the risk factors associated with IFIS, their detailed preoperative assessment and intraoperative measures and surgical intervention is crucial in addressing IFIS. Lack of awareness can turn a routine, uneventful surgery into one with significant visual morbidity.
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Donnenfeld ED, Shojaei RD. Effect Of Intracameral Phenylephrine And Ketorolac 1.0%/0.3% On Intraoperative Pain And Opioid Use During Cataract Surgery. Clin Ophthalmol 2019; 13:2143-2150. [PMID: 31806927 PMCID: PMC6839573 DOI: 10.2147/opth.s229515] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 10/23/2019] [Indexed: 12/14/2022] Open
Abstract
Purpose To compare the effect of Omidria (phenylephrine and ketorolac 1.0%/0.3%) vs epinephrine on pain reduction and opioid usage during cataract surgery. Patients and methods Sixty patients at a single center underwent femtosecond laser (FLACS) or conventional phacoemulsification under topical lidocaine gel anesthesia and intracameral preservative-free lidocaine 1%. Eligible participants were prospectively assigned to receive either intracameral phenylephrine and ketorolac 1.0%/0.3% or intracameral epinephrine. All patients received standardized pre- and post-operative topical therapy. Intravenous (IV) fentanyl was administered for ocular discomfort in patients who complained of intraoperative pain. Outcome measures included both pain (measured by mean visual analog scale (VAS) pain scores from 0 (no pain) to 10 (extreme pain)) and the use of IV fentanyl during surgery. A composite endpoint identified “responders” as being patients who: (1) did not require fentanyl and (2) experienced no to minimal pain (VAS score ≤ 3). Results Forty-one patients were in the phenylephrine and ketorolac 1.0%/0.3% (study) group and 19 were in the epinephrine (control) group. Mean VAS pain scores were significantly (48.9%) lower in the study group than the control group (2.3 vs 4.5; P < 0.0001). The proportion of patients with VAS scores ≤ 3 was significantly greater in the study group (85.0%) than the control group (31.6%) (P < 0.0001). A smaller proportion of patients required intraoperative fentanyl in the study group compared to the control group (9.8% vs 42.1%; P = 0.006). For the composite endpoint, patients receiving phenylephrine and ketorolac 1.0%/0.3% were 94% less likely to require fentanyl or to have moderate-to-severe pain (pain VAS ≥ 4; OR, 0.06; 95% CI 0.02–0.24) than patients receiving epinephrine. Conclusion Our results suggest that the routine use of intracameral phenylephrine and ketorolac 1.0%/0.3% during cataract surgery can significantly reduce patient pain as well as the need for opioids.
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Affiliation(s)
| | - Ryan D Shojaei
- Ophthalmic Consultants of Long Island, Westbury, NY, USA
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Li Y, Zhao Y, Wang Y. 2',3'-Cyclic-nucleotide 3'-phosphodiesterase contributes to epithelial-mesenchymal transition of lens epithelial cells through the notch signalling pathway. Cell Prolif 2019; 52:e12707. [PMID: 31617266 PMCID: PMC6869463 DOI: 10.1111/cpr.12707] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/23/2019] [Accepted: 09/20/2019] [Indexed: 12/12/2022] Open
Abstract
Objectives Fibrosis is a complex process involved in multiple diseases that result in organ injury and failure. Cataract, one common form of ocular fibrosis, is a main cause of blindness worldwide, and surgery may be the only cure. In this regard, epithelial‐mesenchymal transition (EMT) of lens epithelial cells (LECs) is the primary cause of anterior subcapsular cataract (ASC). This study aimed to investigate the mechanism by which 2',3'‐cyclic‐nucleotide 3'‐phosphodiesterase (CNPase) regulates the function of EMT in LECs. Materials and Methods A mouse model of ASC was used to observe the expression of CNPase in the lens and correlate its expression changes with lens EMT. Furthermore, the effects of CNPase on cell migration and cell proliferation were evaluated by transwell migration, wound healing and EdU staining assays. Finally, Western blotting and immunofluorescence were used to assess the mechanical properties potentially involved in the regulation of EMT by CNPase. Results The expression of CNPase was upregulated in LECs during the EMT process in mice with ASC. Notably, CNPase significantly promoted the proliferation, migration and EMT of LECs in vitro. Interestingly, the EMT‐promoting mechanism of CNPase may be achieved by targeting the Notch signalling pathway. Conclusions Considering the involvement of EMT in ASC, both CNPase and the Notch signalling pathway may be therapeutic targets for the treatment of cataracts.
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Affiliation(s)
- Yue Li
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin Eye Hospital, Tianjin, China
| | - Yu Zhao
- Technology Transfer Center, Kunming Medical University, Kunming, China
| | - Yan Wang
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin Eye Hospital, Tianjin, China
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Xu Y, He J, Lin S, Zhang B, Zhu J, Resnikoff S, Lu L, Zou H. General analysis of factors influencing cataract surgery practice in Shanghai residents. BMC Ophthalmol 2018; 18:102. [PMID: 29669533 PMCID: PMC5907364 DOI: 10.1186/s12886-018-0767-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 04/03/2018] [Indexed: 11/10/2022] Open
Abstract
Background It was reported that lack of knowledge, less confidence of medical services, commute difficulties, and poor economic conditions would be the main barriers for cataract surgery practice. The influencing factors could have changed in cities with high developing speed. Shanghai is one of the biggest cities in China and the world. The purpose of the study was to explore the factors influencing cataract surgery practice in Shanghai. Methods This was a population-based, cross-sectional study. A total of 2342 cataract patients older than 50 years old with cataract-induced visual impairment or who had undergone cataract surgery were recruited from rural and urban areas of Shanghai. Participants accepted a face-to-face structured questionnaire. Data were collected on patient demographics, education, work, income, health insurance, awareness about cataracts disease, treatment and related medical resources and deration policy, transportation and degree of satisfaction with hospitals. Results There were 417 patients who had received cataract surgery, 404 of them supplied complete information in the questionnaire. More female subjects (64.6%) than male subjects (35.4%) accepted cataract surgery among the 404 patients. Of the patients with cataract history, 36.4% of surgery patients were equal or older than 80. More people with urban medical insurance received surgery (p = 0.036). Patients who received surgery were more satisfied with local medical service (p = 0.032). In urban area, Lower income and difficulties with commutes were related to a higher rate of surgery. Conclusions Cataract patients with the following features were more inclined to receive surgery: female, old age, better awareness. In urban areas low income and difficult commutes did not represent barriers for cataract surgery, probably because of appropriate cataract surgery promotion policies recent years in Shanghai. In rural areas, better healthcare reimbursement policies would likely lead to a higher uptake of cataract surgery. Further cohort studies with more controls could supply stronger evidence for our viewpoint.
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Affiliation(s)
- Yi Xu
- Shanghai Eye Disease Prevention & Treatment Center / Shanghai Eye Hospital; Shanghai Key Laboratory of Ocular Fundus Diseases; Shanghai General Hospital; Shanghai Engineering Center for Visual Science and Photomedicine, 380 Kangding Road, Shanghai, 200040, China
| | - Jiangnan He
- Shanghai Eye Disease Prevention & Treatment Center / Shanghai Eye Hospital; Shanghai Key Laboratory of Ocular Fundus Diseases; Shanghai General Hospital; Shanghai Engineering Center for Visual Science and Photomedicine, 380 Kangding Road, Shanghai, 200040, China
| | - Senlin Lin
- Shanghai Eye Disease Prevention & Treatment Center / Shanghai Eye Hospital; Shanghai Key Laboratory of Ocular Fundus Diseases; Shanghai General Hospital; Shanghai Engineering Center for Visual Science and Photomedicine, 380 Kangding Road, Shanghai, 200040, China
| | - Bo Zhang
- Shanghai Eye Disease Prevention & Treatment Center / Shanghai Eye Hospital; Shanghai Key Laboratory of Ocular Fundus Diseases; Shanghai General Hospital; Shanghai Engineering Center for Visual Science and Photomedicine, 380 Kangding Road, Shanghai, 200040, China
| | - Jianfeng Zhu
- Shanghai Eye Disease Prevention & Treatment Center / Shanghai Eye Hospital; Shanghai Key Laboratory of Ocular Fundus Diseases; Shanghai General Hospital; Shanghai Engineering Center for Visual Science and Photomedicine, 380 Kangding Road, Shanghai, 200040, China
| | - Serge Resnikoff
- Brien Holden Vision Institute and SOVS, University of New South Wales, Sydney, NSW, Australia
| | - Lina Lu
- Shanghai Eye Disease Prevention & Treatment Center / Shanghai Eye Hospital; Shanghai Key Laboratory of Ocular Fundus Diseases; Shanghai General Hospital; Shanghai Engineering Center for Visual Science and Photomedicine, 380 Kangding Road, Shanghai, 200040, China.
| | - Haidong Zou
- Shanghai Eye Disease Prevention & Treatment Center / Shanghai Eye Hospital; Shanghai Key Laboratory of Ocular Fundus Diseases; Shanghai General Hospital; Shanghai Engineering Center for Visual Science and Photomedicine, 380 Kangding Road, Shanghai, 200040, China
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Waterbury LD. Alternative Drug Delivery for Patients Undergoing Cataract Surgery as Demonstrated in a Canine Model. J Ocul Pharmacol Ther 2017; 34:154-160. [PMID: 29227185 PMCID: PMC5963608 DOI: 10.1089/jop.2017.0048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
PURPOSE (1) To determine ketorolac concentrations in selected ocular tissues following the intracameral administration of phenylephrine and ketorolac injection 1%/0.3% (OMIDRIA®) delivered in irrigation solution during lens replacement surgery in beagle dogs. (2) To compare the ketorolac initial dose and resultant concentrations from the above study to those achieved in aqueous and vitreous by topical administration in patients undergoing cataract surgery or vitrectomy, respectively. METHODS Lens replacement surgery with phacoemulsification was performed in 20 female beagle dogs. A fixed combination of phenylephrine and ketorolac injection 1%/0.3% was diluted 125-fold into the balanced salt solution and delivered intracamerally during the phacoemulsification procedure. Ketorolac concentration was determined by liquid chromatography/mass spectrometry. RESULTS Concentrations of ketorolac when administered by the intracameral route in the dosing solution in dogs were found to be considerably higher in both aqueous and vitreous compared to what is achieved with topical dosing in patients. CONCLUSIONS Adequate therapeutic concentrations of ketorolac in aqueous and vitreous humor were achieved even at 10 h postdose. Critical concentrations in the aqueous that envelopes the iris/ciliary body, which are sites of prostaglandin E2 synthesis, and the vitreous are not achieved by topical dosing in clinical studies after the surgery, but are by direct intracameral dosing as determined in this study. Based on these studies and clinical data, phenylephrine and ketorolac injection 1%/0.3% delivered during surgery as an irrigation solution may preclude the need for topically administered pre- and postoperative NSAIDs.
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