Intracameral mydriatics in phacoemulsification cataract surgery

Abstract

Intracameral mydriatics were a rapid, effective, and safe alternative to topical mydriatics in phacoemulsification. Their use can simplify preoperative routines and in certain high-risk groups, may reduce the risk for cardiovascular side effects.

Intracameral phenylephrine to prevent floppy iris syndrome during cataract surgery in patients on tamsulosin

“…The pupil size was measured from the video recordings in comparison with a standard 2.8 mm keratome as described by Lundberg and Behndig. 6 …”

Effect of intracameral phenylephrine on systemic blood pressure

“…One particular concern with topical instillation is the greater systemic absorption, which has been demonstrated to carry potential cardiovascular risk. 1 Hypertension is a comorbidity for half of patients undergoing cataract operations, and even if medically controlled these patients are already at risk of preoperative rises in blood pressure. 2 Similar studies investigating the blood pressure effects of intracameral adrenaline found no intraoperative fluctuations in blood pressure as compared to or as adjuncts to topical mydriatics.…”

Intracameral Mydriatics in Cataract Surgery

“…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.…”

“…With intracameral mydriatics, the patients perceive less initial glare from the operation microscope light, as the pupil is small at the beginning of the procedure. The intracameral mydriatics concept has been extensively studied from a safety perspective by us and others, and is found to be safe with no increase in corneal endothelial cell loss (Lundberg and Behndig 2003) (including at long-term follow-up), inflammatory reaction, postoperative corneal swelling (Lundberg and Behndig 2003) or macular edema (Johansson, Lundberg et al 2007). Furthermore, in routine surgery, the surgical performance does not differ from when a standard topical mydriatic regimen is used (Behndig and Eriksson 2004).…”