Intravitreal dexamethasone without preservatives as an adjuvant to intravitreal antibiotics does not improve visual acuity (VA) in patients treated for suspected bacterial endophthalmitis after cataract surgery.
This study confirms that the use of topical ibopamine may result in a sustained increase in intraocular pressure of >2 mmHg in the majority of patients, but was only well tolerated in half of them. There may only be a few patients, however, who will clinically benefit from this rise in intraocular pressure. A better formulation or method of administration would be needed.
SUMMARY In a group of 68 patients a double-blind study was performed to assess the effect of preoperative oxybuprocaine 0O4% (Dorsacaine, Novesin) eye drops in comparison with a placebo in preventing surgically induced miosis during extracapsular cataract extraction. One drop of oxybuprocaine 0O4% or placebo was instilled 10 and 5 minutes preoperatively. The pupil diameter was recorded at different stages of the operation. It was found that oxybuprocaine reduced the amount of pupil constriction during the operation significantly as compared with the placebo group, facilitating the removal of lens material and the implantation of an intraocular lens. The effect of oxybuprocaine is considered to be due to anaesthetic action on sensory nerves in the eye, which may inhibit the release of a miotic substance.Miosis induced by surgical trauma is a frequent problem during extracapsular cataract surgery. In spite of vigorous preoperative dilatation with both anticholinergic and sympathicomimetic agents the pupil diameter constricts during the operation. The removal of lens material and the implantation of an intraocular lens in the posterior capsule bag are hampered by this pupil constriction. Epinephrine can be used in the irrigating solution' or injected in small quantities into the anterior chamber.2 3 These solutions are toxic for the endothelium and cause a loss of corneal endothelial cells.4Mechanical and chemical stimulation of the iris-99 and intracranial stimulation of the trigeminal nerve6 '1 produce miosis, increased vascular permeability, and elevation of the intraocular pressure. The reaction seems to be mediated by prostaglandins and by an atropine-resistant neurogenic pathway. The relative contribution of these 2 depends upon the type of stimulus applied.8 Prostaglandin-synthesis inhibitors reduce the amount of miosis during mechanical irritation of the iris significantly both in animals69 [14][15][16][17]
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