Maintenance of Mydriasis with One Bolus of Epinephrine Injection During Phacoemulsification

Abstract

Surgically-induced miosis commonly occurs during cataract extraction surgery, complicating removal of lens cortex and placement of a posterior chamber intraocular lens. To maintain intraoperative mydriasis, one bolus of epinephrine injection was used in our study. The pupillary response to various doses of intracameral epinephrine (0.1 ml of 1:25,000, 1:50,000, 1:100,000, 1:200,000, 1:400,000) was assessed in 60 consecutive patients. The pupil size was measured just prior to the incision, one min after epinephrine injection, after phacoemulsification and after irrigation/aspiration. There was no significant difference among the mean mydriatic responses to the epinephrine concentrations we tested. The 1:400,000 concentration appeared to be as effective as 1:25,000, but two cases of the 1:400,000 group failed to maintain the pupil diameter after irrigation/aspiration. In addition, we found that blood pressure did not elevate after injection of any concentration of epinephrine. We concluded that one bolus of an extremely dilute concentration of epinephrine (i.e., 1:400,000) injection might be effective in maintaining mydriasis during cataract surgery without systemic side effects.

Hemodynamic effects of intraocular epinephrine during cataract surgery: a double blinded placebo controlled randomized clinical trial

“…In Liou SW et al study, pulse rate and blood pressure in patients of the study group, even those with hypertension, showed no significant fluctuation during the surgery (Liou et al 1998). Later, Liou SW et al found that blood pressure did not elevate after injection of epinephrine 1:400,000 (Liou et al 2001). In our study, the patients in the study group, even those with hypertension, showed no increase in blood pressure or in heart rate.…”

Hemodynamic effects of intraocular epinephrine during cataract surgery: a double blinded placebo controlled randomized clinical trial

“…In Liou SW et al study, pulse rate and blood pressure in patients of the study group, even those with hypertension, showed no significant fluctuation during the surgery (Liou et al 1998). Later, Liou SW et al found that blood pressure did not elevate after injection of epinephrine 1:400,000 (Liou et al 2001). In our study, the patients in the study group, even those with hypertension, showed no increase in blood pressure or in heart rate.…”

Pharmacological pupil dilatation after sinus surgery

“…The duration of pupil dilatation after inadvertent spillage or retrograde diffusion through lacrimal duct is variable depending on the amount and immediate washout action. A study on different dilutions of epinephrine to maintain the dilatation of the pupil during cataract surgery did not find significant difference in the mean mydriatic response 11. The effect can last from 4 hours in one case report to 8 hours in another one9, and up to 12 hours in a third report 3.…”

Comparison of the effects of 1/10,000 and 1/100,000 concentrations of intracameral epinephrine on corneal endothelium and macular thickness after uncomplicated phacoemulsification

“…Liou et al have also studied the pupillary response to various concentrations of intracameral epinephrine during cataract surgery. The authors demonstrated that there was no significant difference between the mean mydriatic responses to the epinephrine concentrations they used in their study; they stated that an extremely dilute concentration of epinephrine (i.e., 1:400,000) may be as effective as 1:25,000 concentration in maintaining mydriasis [9]. Intraocular irrigation with adrenaline 1:1,000,000 has also been used for maintaining mydriasis during cataract surgery; it has been demonstrated to be safe and effective [8,20].…”

Hemodynamic effects of intraocular epinephrine during cataract surgery: a double blinded placebo controlled randomized clinical trial

“…In Liou SW et al study, pulse rate and blood pressure in patients of the study group, even those with hypertension, showed no significant fluctuation during the surgery (Liou et al 1998). Later, Liou SW et al found that blood pressure did not elevate after injection of epinephrine 1:400,000 (Liou et al 2001). In our study, the patients in the study group, even those with hypertension, showed no increase in blood pressure or in heart rate.…”

Pharmacological pupil dilatation after sinus surgery

“…The duration of pupil dilatation after inadvertent spillage or retrograde diffusion through lacrimal duct is variable depending on the amount and immediate washout action. A study on different dilutions of epinephrine to maintain the dilatation of the pupil during cataract surgery did not find significant difference in the mean mydriatic response 11. The effect can last from 4 hours in one case report to 8 hours in another one9, and up to 12 hours in a third report 3.…”

Comparison of the effects of 1/10,000 and 1/100,000 concentrations of intracameral epinephrine on corneal endothelium and macular thickness after uncomplicated phacoemulsification

“…Liou et al have also studied the pupillary response to various concentrations of intracameral epinephrine during cataract surgery. The authors demonstrated that there was no significant difference between the mean mydriatic responses to the epinephrine concentrations they used in their study; they stated that an extremely dilute concentration of epinephrine (i.e., 1:400,000) may be as effective as 1:25,000 concentration in maintaining mydriasis [9]. Intraocular irrigation with adrenaline 1:1,000,000 has also been used for maintaining mydriasis during cataract surgery; it has been demonstrated to be safe and effective [8,20].…”

Hemodynamic effects of intraocular epinephrine during cataract surgery: a double blinded placebo controlled randomized clinical trial

“…In Liou SW et al study, pulse rate and blood pressure in patients of the study group, even those with hypertension, showed no significant fluctuation during the surgery (Liou et al 1998). Later, Liou SW et al found that blood pressure did not elevate after injection of epinephrine 1:400,000 (Liou et al 2001). In our study, the patients in the study group, even those with hypertension, showed no increase in blood pressure or in heart rate.…”

Pharmacological pupil dilatation after sinus surgery

“…The duration of pupil dilatation after inadvertent spillage or retrograde diffusion through lacrimal duct is variable depending on the amount and immediate washout action. A study on different dilutions of epinephrine to maintain the dilatation of the pupil during cataract surgery did not find significant difference in the mean mydriatic response 11. The effect can last from 4 hours in one case report to 8 hours in another one9, and up to 12 hours in a third report 3.…”

Comparison of the effects of 1/10,000 and 1/100,000 concentrations of intracameral epinephrine on corneal endothelium and macular thickness after uncomplicated phacoemulsification

“…Liou et al have also studied the pupillary response to various concentrations of intracameral epinephrine during cataract surgery. The authors demonstrated that there was no significant difference between the mean mydriatic responses to the epinephrine concentrations they used in their study; they stated that an extremely dilute concentration of epinephrine (i.e., 1:400,000) may be as effective as 1:25,000 concentration in maintaining mydriasis [9]. Intraocular irrigation with adrenaline 1:1,000,000 has also been used for maintaining mydriasis during cataract surgery; it has been demonstrated to be safe and effective [8,20].…”