An evaluation of intracameral mydriasis for routine cataract surgery

Schulz, C.; Goverdhan, Srini; Humphry, R C

doi:10.1136/bjophthalmol-2017-310510

Cited by 18 publications

(16 citation statements)

References 16 publications

(13 reference statements)

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“…An increased emphasis has been placed on using local anesthesia and administering drugs intracamerally, and studies have shown that intracameral drug administration induces rapid and safe mydriasis. 2,7,8 Studies have focused not only on pupil dilators but also on anti-inflammatory agents and means of maintaining mydriasis with medications injected intracamerally. 16 The introduction and registration of the first ready-to-use combined mydriatic and anesthetic, which can be intracamerally injected, have provided surgeons with a new tool.…”

Section: Discussionmentioning

confidence: 99%

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Stable Mydriasis After Intracameral Injection of a Combination of Mydriatics and Anesthetic During Cataract Surgery: A Real-Life, Multicenter Study

Kęcik

Grabska‐Liberek

Jurowski

et al. 2020

Journal of Ocular Pharmacology and Therapeutics

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Purpose: To evaluate the effect of Mydrane (contains tropicamide, phenylephrine hydrochloride, and lidocaine hydrochloride) on time needed to induce mydriasis and mydriasis stability during cataract surgery. Methods: This was an observational, non-interventional, multicenter study of patients undergoing cataract surgery who received Mydrane for mydriasis and intraocular anesthesia. The study was conducted at seven ophthalmology departments at university hospitals in Poland. Patients admitted for cataract surgery within a 2-week period were asked to participate in the study. Patients whose pupils dilated to a diameter ≥6 mm after topical mydriatic administration during preoperative examinations were scheduled to receive Mydrane and included in the registry. No additional inclusion criteria were used. Patients' medical histories, examination results, and operative details were recorded. Pupil diameter was measured during surgery. Surgeons were asked to complete a Likert-based survey in parallel. Results: A total of 307 patients were enrolled. The mean pupil diameter was 7.0 ± 1.0 mm before capsulorhexis and 6.9 ± 1.2 mm before lens implementation. A pupil diameter ≥6 mm was achieved in 91.9% and 87.6% of patients before capsulorhexis and lens implantation, respectively. We asked 58 surgeons whether they agreed with the statement “Mydriasis was obtained in a short time after the administration of Mydrane”; the surgeons agreed with this statement after 92.2% (283/307) of surgeries. In addition, after 88.2% of surgeries, the surgeons agreed with the statement “Mydriasis was stable after the administration of Mydrane.” Conclusions: Mydriasis was rapidly and stably obtained after Mydrane injection, as demonstrated by pupil diameter measurements during surgery and surgeons' feedback.

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Section: Discussionmentioning

confidence: 99%

“…A new study from a single center assessed pupil diameter during surgery and visual acuity postoperatively; however, this study utilized different measurement points and assessed outcomes based on patient feedback rather than surgeon feedback. 8…”

Section: Introductionmentioning

confidence: 99%

Stable Mydriasis After Intracameral Injection of a Combination of Mydriatics and Anesthetic During Cataract Surgery: A Real-Life, Multicenter Study

Kęcik

Grabska‐Liberek

Jurowski

et al. 2020

Journal of Ocular Pharmacology and Therapeutics

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“…According to our results, the study drug Mydrane™ and the traditional anesthetic formulation seems to have similar efficacy in attenuating pain. Other studies indicated Mydrane™ to be effective also as an intraoperative mydriatic (Labetoulle et al, 2016;Schulz et al, 2018). For these considerations, Davey et al shown that Mydrane™ is a cost effective and safe procedure in United Kingdom (Davey et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

Pain Following the Use of Anesthesia Formulation Among Individuals Undergoing Cataract Surgery: A Randomized Controlled Trial

et al. 2020

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To assess the pain intensity of two intracameral anesthetic solutions in patients undergoing cataract surgery and evaluate the factors influencing the patients' postoperative activities. Methods: Sixty-two patients undergoing cataract surgery were randomized to receive the study druga manufactured solution of 0.02% tropicamide/0.31% phenylephrine/1% lidocaine (Mydrane) or a traditional anesthetic formulation-solution of 1% lidocaine/ 0.025% adrenaline as an intraocular anesthetic. The pain intensity was assessed by Visual Analog Scale for Pain (VAS Pain) and Brief Pain Inventory-short form (BPI) on the next day after the surgery. Results: The mean pain score measured preoperatively with VAS Pain was 0.34 in Mydrane group and 0.09 in the reference group (p = 0.51). There were no statistically significant differences between the two anesthetic methods with respect to pain intensity during the surgery (p = 0.94) and the influence of pain during the last 24 h on activity (p = 0.79), mood (p = 0.31), social contacts (p = 0.29), sleep (p = 0.5) and the joy of life (p = 0.39). Additionally, there was no statistically significant influence of age, sex, lateralization, co-existing ophthalmological diseases (p = 0.98) and post-operative complications (p = 0.4) on the experienced pain measured during the surgery and in the last 24 h. Conclusions: New commercially available intraocular anesthetic solution (Mydrane™) seems to be as effective as off-label traditional anesthetic formulation, in reducing the pain experienced during cataract surgery under topical anesthesia.

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“…Recently, a third strategy consisting of an intracameral injection of tropicamide, phenylephrine, and xylocaine (Mydrane ® ) was brought to the market. This product is only indicated for pre-surgery mydriasis because of the presence of an anesthetic in its composition and its administration route [11,12].…”

Section: Introductionmentioning

confidence: 99%

In Situ Gelling Ophthalmic Drug Delivery System for the Optimization of Diagnostic and Preoperative Mydriasis: In Vitro Drug Release, Cytotoxicity and Mydriasis Pharmacodynamics

Destruel

Zeng²,

Brignole-Baudouin

et al. 2020

Pharmaceutics

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Mydriasis is required prior to many eye examinations and ophthalmic surgeries. Nowadays, phenylephrine hydrochloride (PHE) and tropicamide (TPC) are extensively used to induce mydriasis. Several pharmaceutic dosage forms of these two active ingredients have been described. However, no optimal therapeutic strategy has reached the market. The present work focuses on the formulation and evaluation of a mucoadhesive ion-activated in situ gelling delivery system based on gellan gum and hydroxyethylcellulose (HEC) for the delivery of phenylephrine and tropicamide. First, in vitro drug release was studied to assess appropriate sustained drug delivery on the ocular surface region. Drug release mechanisms were explored and explained using mathematical modeling. Then, in situ gelling delivery systems were visualized using scanning electron microscopy illustrating the drug release phenomena involved. Afterward, cytotoxicity of the developed formulations was studied and compared with those of commercially available eye drops. Human epithelial corneal cells were used. Finally, mydriasis intensity and kinetic was investigated in vivo. Mydriasis pharmacodynamics was studied by non-invasive optical imaging on vigilant rabbits, allowing eye blinking and nasolacrimal drainage to occur physiologically. In situ gelling delivery systems mydriasis profiles exhibited a significant increase of intensity and duration compared with those of conventional eye drops. Efficient mydriasis was achieved following the administration of a single drop of in situ gel reducing the required amount of administered active ingredients by four-to eight-fold compared with classic eye drop regimen.

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An evaluation of intracameral mydriasis for routine cataract surgery

Cited by 18 publications

References 16 publications

Stable Mydriasis After Intracameral Injection of a Combination of Mydriatics and Anesthetic During Cataract Surgery: A Real-Life, Multicenter Study

Stable Mydriasis After Intracameral Injection of a Combination of Mydriatics and Anesthetic During Cataract Surgery: A Real-Life, Multicenter Study

Pain Following the Use of Anesthesia Formulation Among Individuals Undergoing Cataract Surgery: A Randomized Controlled Trial

In Situ Gelling Ophthalmic Drug Delivery System for the Optimization of Diagnostic and Preoperative Mydriasis: In Vitro Drug Release, Cytotoxicity and Mydriasis Pharmacodynamics

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