Comparative Study of Mydriasis in Cataract Surgery: Topical versus Mydriasert versus Intracameral Mydriasis in Cataract Surgery

Morgado, Gabriel; Barros, Pedro; Martins, Joana; Lima, André Meyer Alves de; Martins, Neves

doi:10.1177/112067211002000618

Cited by 32 publications

(43 citation statements)

References 7 publications

(5 reference statements)

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“…In our first two studies, we could se no signs of negative cardiovascular effects from intracameral myriatics (Lundberg and Behndig 2003;Behndig and Eriksson 2004), which is well in accordance with the facts that the doses of the adrenergic and anticholinergic substances are lower when the substance is administered intracamerally, and that there is likely to be a smaller proportion of the drug that enters the lacrimal drainage system with intracameral administration. Morgado et al confirmed in a study from 2010 involving 90 patients that topical mydriatics is more efficient from an initial mydriatic point of view, but intracameral mydriatics are safer from a cardiovascular point of view (Morgado, Barros et al 2010). Taken together, the reports on cardiovascular safety combined with the widespread clinical routine use of intracameral mydriatics are reassuring -the risk of systemic side effects is not likely to be higher with the intracameral route of administration.…”

Section: Cardiovascular Safetysupporting

confidence: 56%

“…As we will see below, a local anesthetic will also have an additive, passive mydriatic effect when injected intracamerally (Cionni, Barros et al 2003). We early found that when using a regimen involving intracameral mydriatics, some of the disadvantages with topical mydriatics are avoided, since the method means no preoperative waiting time and also reduced doses of the mydriatic substances -and thereby likely lowers the risk for systemic side-effects (Lundberg and Behndig 2003) (Morgado, Barros et al 2010). In our own current setting, a preservative-free mixture of phenylephrine 1.5% and lidocaine 1% is used, but other solutions have been proposed and used clinically, mainly preservative-free epinephrine 0.025% with lidocaine 0.75%, or lidocaine 1% only.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Intracameral Mydriatics in Cataract Surgery

Behndig¹,

Lundberg²,

Bäckström³

2013

Cataract Surgery

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Section: Cardiovascular Safetysupporting

confidence: 56%

mentioning

confidence: 99%

Intracameral Mydriatics in Cataract Surgery

Behndig¹,

Lundberg²,

Bäckström³

2013

Cataract Surgery

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“…In the study by Kumar et al, a viscous solution of phenylephrine, 10%, was used, which likely led to greater systemic absorption (Table). As this study provided only Chawdhary et al, 10 1984 Kumar et al, 11 1985 Morgado et al, 12 2010 Mouly et al, 13 10 cases for each of the concentrations and times (overall weighting <5%) and as viscous phenylephrine is not commonly used in clinical practice, the study's results are not representative of BP and HR changes following phenylephrine application in clinical routine and are only retained as a worstcase scenario. No differences were found between studies that used phenylephrine alone and those that combined it with tropicamide, suggesting that concurrent application of tropicamide has no additional effect on BP.…”

Section: Effect On Bpmentioning

confidence: 78%

“…6 In a sample of persons with hypertension with a baseline BP variability of 10 mm Hg per half hour, BP variability at baseline was shown to be associated with target organ damage assessed by presence of arrhythmia, left ventricular mass index, cardiac volume on chest radiography, and retinal hypertensive changes 7 years later, independent of the existing hypertension. 18 In another study, systolic BP variability of 15 mm Hg or less was defined as normal, and an increase more than this was associated with an increased prevalence of ischemic heart disease, severe carotid artery stenosis, and carotid intima media Morgado et al, 12 2010 Mouly et al, 13 2006 Subtotal Phenylephrine, 10%, at 20-30 min after application Chawdhary et al, 10 1984 Yospaiboon et al, 16 2004 than 5 mm Hg is not likely to be of any clinical relevance.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular Adverse Effects of Phenylephrine Eyedrops

et al. 2015

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IMPORTANCE Topical phenylephrine hydrochloride is routinely administered with few safety precautions, but evidence regarding its systemic safety to date is controversial. As even short-term variations in 24-hour blood pressure (BP) and heart rate (HR) can adversely affect cardiovascular health, better evidence on phenylephrine's effects on HR and BP is required.OBJECTIVE To perform a meta-analysis of available evidence regarding cardiovascular adverse effects of topical phenylephrine.DATA SOURCES PubMed, MEDLINE, and the Cochrane Database of Systematic Reviews and Clinical Trials were searched for relevant literature from January 1, 1970, to January 1, 2014, using a combination of the following search terms: topical, ocular, ophthalmic, phenylephrine, tropicamide, cardiovascular effect, side effect, blood pressure, heart rate, mydriatic, and eye drops. A total of 70 articles related to the topic were identified and all full texts were retrieved.STUDY SELECTION Randomized clinical trials reporting change in BP and HR for adults were included in this review. All studies reporting results for neonates or infants, not reporting standard deviations, or not specifying the time of measurement or the concentration of phenylephrine used were excluded.DATA EXTRACTION AND SYNTHESIS Data from randomized clinical trials that reported BP and/or HR as well as the time following administration of topical phenylephrine at which measurements were obtained by concentration of phenylephrine as a mean change and its standard deviation were extracted. Data were synthesized by concentration of phenylephrine and time of measurement following topical application using random-effects models with inverse variance weighting to account for heterogeneity across studies. MAIN OUTCOMES AND MEASURES Difference in BP and HR after topical administration of phenylephrine.RESULTS Eight RCTs with a total of 916 participants were included. Data were available for phenylephrine, 2.5%, at 20 to 30 minutes and 60 minutes or longer after administration, and neither BP nor HR changed at either time. Following application of phenylephrine, 10%, BP increased at 5 and 10 minutes (mean difference for both, +15 mm Hg; 95% CI, 11.94-18.54; P < .001) but decreased at 20 to 30 minutes and 60 minutes or longer with no changes detected against baseline. A mean increase in HR by 4.48 beats/min (95% CI, 1.09-7.88; P = .01) was present at 20 to 30 minutes following application of phenylephrine, 10%, and HR decreased by 60 minutes or longer with no changes detected compared with baseline.CONCLUSIONS AND RELEVANCE Phenylephrine, 2.5%, leads to no clinically relevant change in BP or HR, and the changes in BP and HR seen with phenylephrine, 10%, are short lived. Thus, phenylephrine, 2.5%, is safe to use in clinical routine.

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“…Mydriasert® is an insoluble-matrix, sterile, cylindrical-shaped device containing phenylephrine and tropicamide, which are slowly released following placement into the conjunctival cul-de-sac. The insert, currently approved for use in adults, has been shown to provide an effective and stable mydriasis for surgical and diagnostic procedures [14-17], but has not been tested in patients younger than 18 years old. Interestingly, in adults requiring preoperative mydriasis, the device avoids repeated applications of drops, reducing the nursing time [15, 18].…”

Section: Introductionmentioning

confidence: 99%

Ophthalmic Insert versus Eye Drops for Mydriasis in Neonates: A Randomized Clinical Trial

Bremond-Gignac¹,

Jacqz-Aigrain

Abdoul³

et al. 2018

Neonatology

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Background: Eye drop treatment routinely used to obtain mydriasis prior to fundoscopy in neonates requires repeated instillations of mydriatic agents that can lead to systemic side effects. Objectives: The aim of this study was to compare the mydriatic efficacy and tolerance of administration of phenylephrine and tropicamide via the ophthalmic insert Mydriasert® versus standard eye drop treatment in neonates. Methods: In this prospective, single-blinded, noninferiority study, 80 hospitalized neonates (age < 18 months) requiring bilateral fundus examination were randomized to receive eye drops (repeated instillations of 2.5% phenylephrine and 0.5% tropicamide) or the insert. The primary outcome was mydriasis suitable for fundoscopy 75 min after mydriatic agent introduction (T75). Results: Mydriasis was successfully achieved in both eyes at T75 in 97.5% (n = 39/40) of the insert group patients versus 90% (n = 36/40) receiving eye drops (between-group difference 7.5%, demonstrating noninferiority). Mydriasis remained stable in 60.0% of patients (n = 24/40) in the insert group versus 15% (n = 6/40) in the eye drop group (p < 0.0001). The insert group required fewer nursing interventions than the eye drop group (p = 0.0001). Mean blood pressure were significantly higher in the insert versus the eye drop group (p < 0.0001 and p = 0.0003, respectively); mean heart rate was not significantly different between the groups (p = 0.37). In the insert group, 2 patients reported an adverse event (bradycardia, n = 1, and gastroesophageal reflux, n = 1; both appeared to be related to neonate pathology). Conclusions: The degree of mydriasis achieved with Mydriasert® was noninferior to that obtained with eye drops. The insert appears to be safe to use in neonates without a history of increased vagal tone or gastrointestinal reflux.

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Comparative Study of Mydriasis in Cataract Surgery: Topical versus Mydriasert versus Intracameral Mydriasis in Cataract Surgery

Abstract: The most effective mydriasis was obtained within the Mydriasert group, followed by the topical mydriasis group. From the cardiovascular point of view, intracameral mydriasis was the safest and topical mydriasis the least safe.

Cited by 32 publications

References 7 publications

Intracameral Mydriatics in Cataract Surgery

Intracameral Mydriatics in Cataract Surgery

Cardiovascular Adverse Effects of Phenylephrine Eyedrops

Ophthalmic Insert versus Eye Drops for Mydriasis in Neonates: A Randomized Clinical Trial

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