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Journal of Cataract and Refractive... Aug 2017To evaluate the efficacy and safety of intracameral mydriatics (lidocaine 1.0% and phenylephrine 1.5%) versus topical mydriatics (phenylephrine 2.5% and tropicamide...
PURPOSE
To evaluate the efficacy and safety of intracameral mydriatics (lidocaine 1.0% and phenylephrine 1.5%) versus topical mydriatics (phenylephrine 2.5% and tropicamide 1.0%) in pupil dilation for phacoemulsification surgery in Malaysians.
SETTING
Department of Ophthalmology, Penang General Hospital, Georgetown Penang, Malaysia.
DESIGN
Prospective comparative case series.
METHOD
Patients with immature cataract were randomized to the topical mydriatic group (topical group) or intracameral mydriatic group (intracameral group). Patients with small pupils and complicated cataracts were excluded. Pupil diameter changes were measured throughout the surgery. Additional pupil dilation maneuvers and complications were recorded.
RESULTS
The study comprised 112 patients. There was no difference in mean pupil dilation between the intracameral group (4.86 mm ± 0.74 [SD]) and the topical group (4.88 ± 0.91 mm) (P = .86). However, the mean pupil size before capsulorhexis in the topical group (7.23 ± 1.08 mm) was significantly larger than in the intracameral group (6.40 ± 0.80 mm) (P = .01). The pupils in the intracameral group continued to dilate during surgery (0.44 ± 0.62 mm), while those in the topical group constricted (-0.41 ± 1.04 mm) (P < .001). Three patients in the intracameral group and 6 in the topical group required additional maneuvers for pupil dilation (P = .49). Each group had 1 complication (P = 1.00).
CONCLUSIONS
Intracameral mydriatic agents dilated heavily pigmented pupils for phacoemulsification cataract surgery. However, in the early stages of surgery, pupil dilation was slower than with topical agents.
Topics: Capsulorhexis; Cataract Extraction; Dilatation; Humans; Injections; Lens, Crystalline; Lidocaine; Mydriasis; Mydriatics; Phacoemulsification; Phenylephrine; Prospective Studies; Pupil
PubMed: 28917402
DOI: 10.1016/j.jcrs.2017.05.031 -
Current Opinion in Ophthalmology Oct 1998Proprioceptive receptors have long been known anatomically to be present in extraocular muscles, specifically at the myotendinous junction. Their function in regulating... (Review)
Review
Proprioceptive receptors have long been known anatomically to be present in extraocular muscles, specifically at the myotendinous junction. Their function in regulating smooth pursuits is experimentally demonstrated. The clinical significance of this for strabismus is still unknown. Esotropia surgery before resolution of moderate amblyopia is not detrimental. Botulinum toxin injections will correct infantile esotropia but require more anesthesia sessions overall than does conventional surgery, increasing cost. Late-onset comitant esotropia is usually refractive in nature and rarely neurologic. Comitant esodeviation is also prevalent in children with known neurologic insults. In both situations, it is the associated neurologic signs that point to the underlying neurologic cause. Posterior fixation suture will correct a high accommodative convergence/accommodation ratio esotropia. Exotropia negatively affects patients' quality of life. Surgical outcomes differ in patients whose angle of deviation increases with 1 hour of occlusion testing at extreme distances ("outdoor sensitivity"). Recession resection influences the distance and near angles of deviation equally whereas bilateral lateral rectus resection influences the distance deviation more than the near. Spray administration of cycloplegic agents to closed eyelids has been shown to be as effective as administration of eye drops. The spray is much better tolerated by patients and easier to administer. Photorefraction, although not yet effective as a screening tool, is useful to document alignment and refractive errors.
Topics: Administration, Topical; Animals; Humans; Mydriatics; Oculomotor Muscles; Ophthalmologic Surgical Procedures; Refraction, Ocular; Strabismus; Therapeutic Irrigation
PubMed: 10387475
DOI: 10.1097/00055735-199810000-00004 -
Expert Opinion on Pharmacotherapy May 2010The term 'uveitis' covers a broad spectrum of ocular inflammation affecting the iris, ciliary body, and/or the choroid, all of which comprise the uveal tract. Severe... (Review)
Review
IMPORTANCE OF THE FIELD
The term 'uveitis' covers a broad spectrum of ocular inflammation affecting the iris, ciliary body, and/or the choroid, all of which comprise the uveal tract. Severe cases of uveitis need be treated aggressively to prevent damage caused by chronic inflammation. Untreated or poorly managed cases can lead to ciliary body dysfunction, inadequate aqueous production, chorioretinal damage, and possibly blindness.
AREAS COVERED IN THIS REVIEW
There are many medications that can be used to treat uveitis. Corticosteroids are available in several formulations: topical drops, regional injections, oral and intravenous. Immunomodulatory agents that can be used for uveitis are antimetabolites, T-cell inhibitors, alkylating agents, and biologic response modifiers. These medications, their appropriate uses, and side effect monitoring will be detailed.
WHAT THE READER WILL GAIN
There is a stepladder approach to treatment of ocular inflammation. Corticosteroids are the treatment of choice for treating acute flares. Steroid free remission is the goal of therapy and can be achieved with the use of chemotherapeutic agents. Which medications are appropriate and how to escalate therapy will be reviewed.
TAKE HOME MESSAGE
Chronic systemic corticosteroid therapy is not an acceptable long treatment plan for uveitis, unless all other medications have failed. Steroid sparing immunosuppressive therapy should be pursued as soon as acute flares of uveitis have been controlled.
Topics: Animals; Glucocorticoids; Humans; Immunosuppressive Agents; Mydriatics; Severity of Illness Index; Time Factors; Uveitis
PubMed: 20367272
DOI: 10.1517/14656561003713534 -
Journal of the American Veterinary... Jan 1962
Topics: Animals; Dogs; Mydriatics; Ophthalmoscopy
PubMed: 14494914
DOI: No ID Found -
Deutsches Arzteblatt International May 2022
Topics: Humans; Mydriatics; Ophthalmic Solutions
PubMed: 35974463
DOI: 10.3238/arztebl.m2022.0095 -
Journal of Cataract and Refractive... Aug 2021
Topics: Cataract; Cataract Extraction; Humans; Lens, Crystalline; Mydriatics; Pupil
PubMed: 34290193
DOI: 10.1097/j.jcrs.0000000000000726 -
Acta Ophthalmologica Nov 2013To compare the mydriatic effect of intracameral mydriatics injected into the anterior or the posterior chamber in routine phacoemulsification cataract surgery. (Comparative Study)
Comparative Study Randomized Controlled Trial
PURPOSE
To compare the mydriatic effect of intracameral mydriatics injected into the anterior or the posterior chamber in routine phacoemulsification cataract surgery.
METHODS
Forty-four patients planned for unilateral phacoemulsification surgery were included after informed consent. Mydriasis was achieved by injecting 150 μl of a mixture of phenylephrine 1.5% and lidocaine 1.0% at the beginning of the procedure. The patients were randomly assigned to injection into the anterior or the posterior chamber. The pupils were filmed during the procedures, and the mean pupil diameters were measured at predetermined intervals from the video recordings by an independent observer.
RESULTS
Immediately after the injection, the pupils were larger after posterior chamber injection (3.8 ± 0.8 versus 3.1 ± 0.7 mm; p = 0.004). A similar difference was seen after the phacoemulsification (6.4 ± 0.7 versus 5.9 ± 1.0 mm; p = 0.031). The mydriatic durability was also better after posterior injection (p = 0.004-0.041).
CONCLUSIONS
Apart from immediately after the injection, the initial mydriatic response was similar with both injection techniques, but the durability of the mydriasis was slightly better after a posterior chamber injection of ICM.
Topics: Aged; Anterior Chamber; Drug Combinations; Female; Humans; Injections, Intraocular; Lens Implantation, Intraocular; Lidocaine; Male; Mydriatics; Phacoemulsification; Phenylephrine; Pupil
PubMed: 22963348
DOI: 10.1111/j.1755-3768.2012.02491.x -
Journal of the American Optometric... Sep 1983Clinicians use various topical agents for mydriasis in evaluation of the retina and its periphery. This paper shows the use of two mydriatic methods for this... (Comparative Study)
Comparative Study
Clinicians use various topical agents for mydriasis in evaluation of the retina and its periphery. This paper shows the use of two mydriatic methods for this procedure--a combination of one drop 1% tropicamide (Mydriacyl) and the drop 1% hydroxyamphetamine hydrobromide (Paredrine) in comparison with the regimen of two drops 1% tropicamide (Mydriacyl) separated by five minutes. The degree of dilation, the resistance to intense comparable binocular indirect ophthalmoscope (BIO) illumination and the time recovery from these agents were evaluated in an optometric clinical setting. The same degree of mydriasis was demonstrated at the p greater than 0.01 level with these two regimens. The two regimens appear to be clinically similar for cycloplegic and mydriatic recovery time.
Topics: Adult; Drug Administration Schedule; Female; Humans; Male; Mydriatics; Ophthalmoscopy; Pupil; Tropicamide; p-Hydroxyamphetamine
PubMed: 6619480
DOI: No ID Found -
Journal of Cataract and Refractive... May 2021To compare intracameral and topical mydriatics and anesthetics in cataract surgery. (Randomized Controlled Trial)
Randomized Controlled Trial
Phase IV clinical study to evaluate the effects of an intracameral combined mydriatic and anesthetic agent and standard topical mydriatics and anesthetics on the ocular surface after cataract surgery.
PURPOSE
To compare intracameral and topical mydriatics and anesthetics in cataract surgery.
SETTING
Institute of Ocular Microsurgery, Barcelona, Spain.
DESIGN
Phase IV, open-label, randomized, single-center study.
METHODS
Patients were randomized in a 1:1 ratio to receive intracameral mydriatic-anesthetic (Mydrane/Fydrane) and anesthetic eyedrops or control (topical eyedrops only). The other treatment was administered for the second cataract surgery. Assessments were performed at presurgery and immediately postsurgery, at 12 to 36 hours postsurgery (day 1), and 7 days postsurgery. The primary endpoint was the change from baseline in corneal/conjunctival surface staining. The secondary endpoints included assessments of epithelial alterations, point-spread function, ocular surface disease index, conjunctival hyperemia, vision breakup time, ocular symptoms/signs, adverse events (AEs), corrected distance visual acuity, intraocular pressure, patient/investigator satisfaction, and procedure time.
RESULTS
A total of 50 patients undergoing sequential cataract surgery in both eyes were included. Baseline assessments were similar in each group. The difference between Fydrane and control groups for the change from baseline at day 1 in corneal and conjunctival surface staining was not statistically significant. For Fydrane, postoperative epithelial alterations were fewer at day 1 (P < .005), folliculopapillary reaction was less frequent (P < .05), some ocular symptoms were less frequent and milder (P < .05), length of procedure was shorter (P < .001), and patient and investigator satisfaction were better (P < .05). There were few AEs in both groups.
CONCLUSIONS
Fydrane reduced ocular surface damage by decreasing corneal epithelial and conjunctival toxicity with faster recovery of surface integrity compared with topical eyedrops, improved patient and investigator satisfaction, and reduced procedure time.
Topics: Anesthetics, Local; Cataract; Humans; Lidocaine; Mydriatics; Ophthalmic Solutions; Prospective Studies; Spain
PubMed: 33196565
DOI: 10.1097/j.jcrs.0000000000000491 -
Survey of Ophthalmology 2022Intracameral phenylephrine is commonly used in ophthalmic surgery as an alternative or supplement to mydriatic eye drops; hence, the importance of an evidence-based... (Review)
Review
Intracameral phenylephrine is commonly used in ophthalmic surgery as an alternative or supplement to mydriatic eye drops; hence, the importance of an evidence-based understanding of its risk-benefit profile is vital. We performed a comprehensive search in the PubMed, Google Scholar, and Cochrane databases for published studies and case reports relating to the use of intracameral phenylephrine. Articles from 1958 to 2021 with the following keywords were used: "intracameral phenylephrine," "intracameral mydriatics," "phenylephrine," "pupil dilation," "complications." Intracameral phenylephrine was first used in 2003 as an alternative to topical mydriatics. Since then, it is being increasingly used with a variety of benefits, including rapid onset of mydriasis, and cost-effectiveness. There are various case reports, however, of ocular and systemic complications associated with intracameral phenylephrine such as generation of free radicals, toxic anterior segment syndrome, inconsistent pupillary dilation during surgery, and ventricular fibrillation. Alternatives to intracameral phenylephrine such as iris hooks, a Malyugin ring, intracameral epinephrine, and intracameral tropicamide were compared with intracameral phenylephrine. Intracameral phenylephrine appears to have a good safety profile.
Topics: Humans; Lidocaine; Mydriatics; Ophthalmic Solutions; Phacoemulsification; Phenylephrine; Pupil
PubMed: 35691387
DOI: 10.1016/j.survophthal.2022.06.002