Facoemulsificación sin midriasis preoperatoria: beneficios para el paciente

Abstract

Lidocaine 1% plus epinephrine 1/200,000 as an adjunct to topical anesthesia during phacoemulsification showed to be an effective and safe alternative to abolish side effects caused by systemic absorption of mydriatics eye-drops before surgery.

Phacoemulsification without preoperative topical mydriatics: Induction and sustainability of mydriasis with intracameral mydriatic solution

“…[21] The efficacy of mydriatic solution composed of lignocaine (0.75%-1%) with epinephrine 0.025% in inducing and maintaining pupillary mydriasis during phacoemulsification has been demonstrated earlier. [28]…”

“…Systemic safety of these topical formulae containing beta agonists and parasympatholytics is doubtful as they are known to cause a rise in blood pressure,[1] ataxia, dizziness and dry mouth. [2] Often due to noncompliance of the patient or staff there may be no dilatation or poor dilatation leading to delay in start of surgery causing wastage of man hours and resources. Due to these problems there has been an attempt to search for alternatives to this repeated eye drop instillation regimen.…”

“…Various options like single drop instillation,[3] Ocular inserts,[4] depot preparation of mydriatic,[5] and intracameral irrigation of mydriatic-cycloplegic drugs have been used with comparable results. [267] Out of these only intracameral irrigation can obviate the need of pre-operative preparation. For this purpose many drugs have been used, namely…”

“…Lignocaine (0.75%-1%) with epinephrine 0.025%,[28]Lignocaine solution 1%,[91011]Cyclopentolate 0.1%, phenylephrine 1.5%, and lignocaine 1%[7812] …”

Mydriasis with different preparations of topically administered lidocaine hydrochloride

“…16,17 In contrast, local anesthetic agents have few systemic side effects and used in a proper fashion to contribute to mydriasis, may reduce the need for adrenergics/ cholinergics and increase patient safety and comfort. 9,10,18 The present study was designed from this perspective to assess the optimal concentration, pH, and dosage of topical lidocaine hydrochloride in rendering a maximum mydriatic response without the corneal side effects of tetracaine hydrochloride 1% that we previously reported. 8 Studies show that local anesthetic agents in buffered solutions with a higher pH give a better, more prolonged anesthetic effect 19,20 and superior corneal penetration.…”