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Journal of Ocular Pharmacology and... Jun 2021To evaluate whether the standard dilating drop regimen consisting of phenylephrine, tropicamide, and proparacaine produces clinically significant improvement in pupil... (Comparative Study)
Comparative Study Randomized Controlled Trial
To evaluate whether the standard dilating drop regimen consisting of phenylephrine, tropicamide, and proparacaine produces clinically significant improvement in pupil size compared to tropicamide and proparacaine during diagnostic eye examination. Sixty-three adult patients at Washington University School of Medicine Eye Clinic were enrolled in this prospective, randomized trial. Each patient received one of two dilating drop regimens: phenylephrine + tropicamide + proparacaine (PE+T+PP), which is considered the standard therapy, or tropicamide + proparacaine (T+PP). Main outcome measures were the proportion of pupils able to achieve successful clinical examination without need for additional dilating drops and change in predilation to postdilation pupil size. Comparisons were made using McNemar's test, repeated measures analysis of variance, and Fisher's test to determine whether PE is a necessary component of the standard eye examination. There were no statistically significant differences between the PE+T+PP and T+PE treatment groups in predilation to postdilation changes in average resting pupil size (1.58 ± 0.66 and 2.61 ± 0.79; = 0.57) or constricted pupil size (2.52 ± 0.93 and 3.56 ± 0.96; = 0.15). There was no statistically significant difference between patients who obtained a successful dilated pupil examination between those receiving PE+T+PP and those receiving T+PP as determined by the examining physicians (Fisher's, = 0.67). The addition of phenylephrine to tropicamide and proparacaine did not improve pupillary dilation size or ability to conduct a clinical examination. A single dilating agent using tropicamide should be considered in clinical practice.
Topics: Adult; Aged; Anesthetics, Local; Diagnostic Techniques, Ophthalmological; Drug Interactions; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Mydriatics; Ophthalmic Solutions; Outcome Assessment, Health Care; Phenylephrine; Propoxycaine; Prospective Studies; Pupil; Tropicamide
PubMed: 33685234
DOI: 10.1089/jop.2020.0111 -
Biotechnology and Applied Biochemistry Feb 2022Oxidative stress is to upregulate the pentose phosphate pathway (PPP). The PPP consists of two functional branches, glucose-6-phosphate dehydrogenase (G6PD) and...
Oxidative stress is to upregulate the pentose phosphate pathway (PPP). The PPP consists of two functional branches, glucose-6-phosphate dehydrogenase (G6PD) and 6-phosphogluconaste dehydrogenase (6PGD). Glutathione reductase (GR) has a significant role in catalyzing an oxidized glutathione form into a reduced form. The purpose of this study is to investigate the effects of brimonidine and proparacaine on the activity of 6PGD, G6PD, and GR enzymes purified from human erythrocytes. Brimonidine displayed considerable inhibition profile against G6PD with IC value and K constant of 29.93 ± 3.56 and 48.46 ± 0.66 μM, respectively. On the other hand, proparacaine had no inhibitory effect against G6PD. K values were found to be 66.06 ± 0.78 and 811.50 ± 11.13 μM for brimonidine and proparacaine, respectively, for 6PGD. K values were found to be 144.10 ± 2.01 and 1,654.00 ± 26.29 μM for brimonidine and proparacaine, respectively, for GR. Herein, also in silico molecular docking studies were performed between drugs and enzymes.
Topics: Brimonidine Tartrate; Glucose-6-Phosphate; Glucosephosphate Dehydrogenase; Glutathione; Glutathione Reductase; Humans; Molecular Docking Simulation; Pentose Phosphate Pathway; Phosphogluconate Dehydrogenase; Propoxycaine
PubMed: 33438819
DOI: 10.1002/bab.2107 -
Retina (Philadelphia, Pa.) Jun 2021Lidocaine gel was suggested to be highly effective in providing anesthesia for intravitreal injections but adverse effects include a possibility of making sterilization... (Comparative Study)
Comparative Study
PURPOSE
Lidocaine gel was suggested to be highly effective in providing anesthesia for intravitreal injections but adverse effects include a possibility of making sterilization of the conjunctiva difficult. Hence, we wished to determine the effect of using 0.5% proparacaine drops alone over the use of 3.5% lidocaine hydrochloride gel anesthesia during office-based intravitreal injections.
METHODOLOGY
This was a case-control study in patients who came routinely to the clinic for antivascular endothelial growth factor injections. Eyes were treated with one of two anesthesia modalities. A total of 216 injections in 120 patients were reviewed. One group (N = 107) underwent anesthesia with 0.5% proparacaine drops, and the control group (N = 109) received 3.5% lidocaine gel. The pain perceived after injection was graded using the numerical rating scale, and score was immediately recorded by the "masked" injecting physician.
RESULTS
The mean pain score (±SD) for the proparacaine-only group versus gel group was 1.97 (±1.17) versus 1.76 (±0.92), P value = 0.3174. There was no statistical difference between the 2 groups.
CONCLUSION
3.5% lidocaine gel is not superior to 0.5% proparacaine drops as patients attained good pain control and excellent rates of overall satisfaction with proparacaine drops alone.
Topics: Aged; Aged, 80 and over; Anesthesia, Local; Anesthetics, Local; Case-Control Studies; Drug Substitution; Female; Humans; Intravitreal Injections; Lidocaine; Male; Middle Aged; Ophthalmic Solutions; Propoxycaine; Prospective Studies
PubMed: 33141787
DOI: 10.1097/IAE.0000000000003013 -
International Ophthalmology Feb 2021To evaluate the corneal anesthetic effect following topical application of tramadol alone and in combination with dexmedetomidine, and compare it to proparacaine, in...
PURPOSE
To evaluate the corneal anesthetic effect following topical application of tramadol alone and in combination with dexmedetomidine, and compare it to proparacaine, in clinically healthy rats.
METHODS
A randomized, crossover study was performed. Twenty Wistar albino rats (n = 40 eyes) were used. Corneal touch threshold (CTT) measurements (in mm) were obtained using a Cochet-Bonnet aesthesiometer. CTT measurements were obtained at baseline, 1-min following application of the topical anesthetic agent, and repeated at 5-min intervals up to 75 min. The topical protocol involved 3 treatment conditions, separated by a 2-week washout period: proparacaine, tramadol alone, and tramadol in combination with dexmedetomidine.
RESULTS
CTT values were significantly decreased compared to baseline at each timepoint until completion of the 75-min evaluation in all treated eyes, regardless of the assigned treatment (p < 0.0083). With tramadol, complete corneal anesthesia (CTT = 0) was achieved within 1-5 min in 18 eyes and ranged from 5 to 25 min. Co-administration of dexmedetomidine to tramadol resulted in significantly increased CTT values from 5 to 20 min following topical application, compared to tramadol alone (p < 0.0083), and complete corneal anesthesia was achieved in only 14 out of 20 treated eyes.
CONCLUSION
Tramadol might be a useful alternative to topical anesthetic agents, providing a dose-related corneal anesthetic effect. Co-administration of dexmedetomidine does not potentiate its anesthetic effect. The underlying mechanism(s) of drug antagonism between tramadol and dexmedetomidine remains to be determined.
Topics: Animals; Rats; Anesthetics, Local; Cornea; Cross-Over Studies; Dexmedetomidine; Ophthalmic Solutions; Propoxycaine; Rats, Wistar; Tramadol
PubMed: 33095346
DOI: 10.1007/s10792-020-01596-x -
Ophthalmology May 2021
Topics: Adult; Aged; Aged, 80 and over; Cataract Extraction; Drug Delivery Systems; Female; Humans; Male; Middle Aged; Ofloxacin; Ophthalmic Assistants; Ophthalmic Solutions; Povidone-Iodine; Propoxycaine; Tropicamide; Video Recording
PubMed: 32998051
DOI: 10.1016/j.ophtha.2020.09.029 -
Journal of Pharmaceutical and... Oct 2020Proparacaine hydrochloride is an ester-type local anesthetic agent that is extensively used in ophthalmic operations. The process-related impurities of proparacaine...
Proparacaine hydrochloride is an ester-type local anesthetic agent that is extensively used in ophthalmic operations. The process-related impurities of proparacaine hydrochloride were investigated, and seven impurities were detected in the reaction solution of the last step at the level of 0.03-1.08 % by a newly developed HPLC method. Based on the synthetic process and the results of LC-HRMS, the structures of five impurities were proposed as 3-amino-4-propoxybenzoic acid (Imp-A), ethyl 3-amino-4-propoxybenzoate (Imp-B), 2-(ethylamino)ethyl 3-amino-4-propoxybenzoate hydrochloride (Imp-C), 2-(diethylamino)ethyl 3-nitro-4-propoxybenzoate hydrochloride (Imp-F), and 3-nitro-4-propoxybenzoic acid (Imp-G). And the structures were confirmed by synthesis, followed by varieties of spectral and chromatographic analyses. The structures of two impurities with almost same molecular weight in LC-HRMS were elucidated as 2-(diethylamino)ethyl 3-(ethylamino)-4-propoxy-benzoate hydrochloride (Imp-D) and 2-(diethylamino)ethyl 3-formamido-4-propoxybenzoate hydrochloride (Imp-E) by NMR and IR. An HPLC-based method was developed, and validation study demonstrated that the approach was precise, accurate, and sensitive. The impurities information of proparacaine hydrochloride can be used for the quality control of intermediate, raw material drug and its commercial products.
Topics: Chromatography, High Pressure Liquid; Drug Contamination; Magnetic Resonance Spectroscopy; Propoxycaine; Quality Control
PubMed: 32798917
DOI: 10.1016/j.jpba.2020.113497 -
Cornea Oct 2020
Topics: Adolescent; Adult; Anesthetics, Local; Female; Humans; Lacrimal Apparatus; Male; Propoxycaine; Tears; Young Adult
PubMed: 32618855
DOI: 10.1097/ICO.0000000000002410 -
Journal of Ocular Pharmacology and... May 2020
Topics: Anesthetics, Local; Anterior Eye Segment; Cornea; Corneal Diseases; Diagnosis, Differential; Dry Eye Syndromes; Humans; Microscopy, Confocal; Neuralgia; Ophthalmic Solutions; Propoxycaine; Tears
PubMed: 32074469
DOI: 10.1089/jop.2020.29064.res -
European Journal of Ophthalmology Nov 2020We sought to evaluate whether additional topical anesthetic, specifically proparacaine 0.5%, improved patient experience with intravitreal injections without hindering... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
We sought to evaluate whether additional topical anesthetic, specifically proparacaine 0.5%, improved patient experience with intravitreal injections without hindering antisepsis.
METHODS
A prospective, randomized controlled trial was conducted including 36 eyes of 36 patients undergoing intravitreal injections. Patients were randomized to treatment with additional topical proparacaine 0.5% versus control after undergoing informed consent. All patients prior to intravitreal injection underwent conjunctival culture after one drop of topical proparacaine 0.5% was placed. Half of patients then received an additional drop of proparacaine and then underwent a second conjunctival culture. The other half of patients had a drop of povidone iodine and then a second conjunctival culture. Intravitreal injection followed conjunctival cultures. To evaluate their experience, patients were provided with a survey.
RESULTS
In total, 36 patients were enrolled in the study. Three of 36 (8.3%) patients had positive conjunctival cultures after proparacaine eye drops alone. One of 17 (5.8%) patients had a positive conjunctival culture after a second drop of proparacaine. One of 19 (5.3%) patients had a positive culture after proparacaine and povidone iodine. By noninferiority analysis, proparacaine was inferior to povidone iodine ( = .28). Patient experience surveys did not differ between groups.
CONCLUSION
Patient perception did not significantly differ whether or not additional proparacaine drops were used prior to intravitreal injection in a randomized controlled trial. While proparacaine has some antiseptic properties, these were found to be inferior to those of povidone iodine. Therefore, while povidone iodine is essential for antisepsis, additional proparacaine drops should not interfere with antisepsis.
Topics: Aged; Aged, 80 and over; Anesthetics, Local; Endophthalmitis; Eye Infections, Bacterial; Female; Humans; Intravitreal Injections; Male; Middle Aged; Ophthalmic Solutions; Propoxycaine; Prospective Studies
PubMed: 31983237
DOI: 10.1177/1120672120902026 -
Psychiatria Danubina Sep 2019
Review
Topics: Behavior, Addictive; Diagnostic Errors; Eye Pain; Humans; Male; Middle Aged; Ophthalmic Solutions; Patient Satisfaction; Prescription Drug Misuse; Propoxycaine; Self Medication
PubMed: 31596831
DOI: 10.24869/psyd.2019.360