A Bisulfite-free Intraocular Epinephrine Solution

Slack, James W.; Edelhauser, Henry F.; Helenek, Mary J.

doi:10.1016/s0002-9394(14)76942-9

Cited by 14 publications

(12 citation statements)

References 6 publications

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“…Previous studies found that intracameral injection of epinephrine at concentrations up to 0.1% was not harmful to rabbit CECs as determined by measurements of corneal thickness, corneal endothelial cell density, and cellular morphology in control and experimental animals. 23,24 In our study, lidocaine 1% E, containing epinephrine 0.001% (1:100,000), was not cytotoxic to CECs exposed to the agent for up to 8 minutes. This result supports clinical observations that the corneal endothelium is not harmed by intracameral irrigation with a solution of BSS with epinephrine 0.0002% (1 mg of epinephrine added to 500 mL BSS) to maintain pupil dilation during cataract surgery or by a bolus intracameral injection of epinephrine 0.01% before or during cataract surgery to facilitate mydriasis in patients with small pupils.…”

Section: Lack Of Cytotoxicity Of Epinephrine In Commercial (With Presmentioning

confidence: 45%

Cytotoxicity of Lidocaine or Bupivacaine on Corneal Endothelial Cells in a Rabbit Model

Chang

Tseng

et al. 2006

Cornea

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One-minute exposure to lidocaine 1% E or 2% E appears to be safe for cultured rabbit CECs, although longer exposures could cause time-dependent cytotoxicity, which should be considered in planning cataract or other ocular surgery. Because bupivacaine 0.5% and 0.5% spinal heavy cause cytotoxic effects within the first minute of contact with CECs, they should be used with great caution, if at all, in the anterior chamber of human eyes.

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Section: Lack Of Cytotoxicity Of Epinephrine In Commercial (With Presmentioning

confidence: 45%

Cytotoxicity of Lidocaine or Bupivacaine on Corneal Endothelial Cells in a Rabbit Model

Chang

Tseng

et al. 2006

Cornea

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“…[27] Thus epinephrine solution toxicity to endothelium is the byproduct of formulations rather than the molecule itself. So, either an endothelial friendly formulation[28] or maximum dilution of available formulation (which is corneal endothelium compatible with regard to concentration and pH) appear to be the possible answers for safe use of intracameral epinephrine.…”

Section: Discussionmentioning

confidence: 99%

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

Gupta¹,

Kumar²,

Agarwal³

et al. 2014

Indian J Ophthalmol

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Context:Intracameral mydriatic solution can eliminate the disadvantages of repeated eye drop instillation regimen and provide adequate mydriasis for phacoemulsification with added advantages.Aims:Evaluating the role of intracameral irrigating solution (0.5% lignocaine + 0.001% epinephrine) in initiating and maintaining the pupillary mydriasis during phacoemulsification. Secondary aims were to observe the effect of surgical time, nucleus density and ultrasound time on mydriasis during the procedure.Settings and Design:The study is a prospective interventional case series, conducted at tertiary care institution.Materials and Methods:Thirty patients underwent phacoemulsification under topical anesthesia for visually significant cataract. Pupillary dilatation was achieved by intracameral irrigation of mydriatic solution alone. Pupillary diameter was measured serially during surgery and ultrasound time and total surgical time were noted.Statistical Analysis Used:Paired samples student–t test was done to compare means. Spearman correlation coefficient was used to study the effect of various parameters on mydriasis.Results:Thirty eyes completed the study. The pupil size increased from 2.1 mm (Range 2-3.5 mm SD ± 0.32) to 6.9 mm (Range 5-9 mm SD ± 1.02) in 30 seconds time after intracameral mydriatic solution delivery, and was 7.0 mm (Range 3.5 - 9 mm SD ± 0.20) at the end of surgery. Duration of surgery, grade of nucleus and ultrasound time had statistically insignificant effect on mydriasis.Conclusions:Intracameral solution containing 0.5% lignocaine and 0.001% epinephrine provides rapid mydriasis which is adequate for safe phacoemulsification and is unaffected by other parameters.

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“…[17–21] However, in undiluted and weakly diluted solutions, the bisulfite preservative included in most epinephrine preparations is shown to cause corneal endothelial damage and subsequent corneal haziness. [2223]…”

Section: Discussionmentioning

confidence: 99%

Effect of preoperative use of topical prednisolone acetate, ketorolac tromethamine, nepafenac and placebo, on the maintenance of intraoperative mydriasis during cataract surgery: A randomized trial

Zanetti

Fulco

Chaves

et al. 2012

Indian J Ophthalmol

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Purpose:To compare the effects of preoperative use of topical anti-inflammatory prednisolone acetate, ketorolac tromethamine, nepafenac and placebo, on the maintenance of intraoperative mydriasis during cataract surgery.Design:Randomized clinical trial.Materials and Methods:This single-center, masked, randomized clinical study comprised 140 patients scheduled for cataract surgery. Patients (35 in each group) were randomized to receive placebo, prednisolone acetate, ketorolac tromethamine 0.4% or nepafenac. These eye drops were administered three times daily for the two days prior to surgery. The pupillary diameters were measured by the surgeon using a compass prior to the corneal section and at the end of surgery. The primary outcome was the number of patients with pupil ≥ 6mm at the end of the surgery; the secondary outcome was the number of patients with pupil ≥ 6mm at the beginning of the surgery.Results:All the patients achieved pupil ≥ 6mm at the beginning of the surgery. The number of patients in the prednisolone (29/35), nepafenac (31/35) and ketorolac (30/35) groups with pupil ≥ 6mm was greater than in the placebo group in the maintenance of intraoperative mydriasis (19/35 – P =0.003). There was no statistical difference among the prednisolone, nepafenac and ketorolac groups in the maintenance of intraoperative mydriasis (P =.791). There were no complications during surgery or related to the preoperative use of the eye drops.Conclusion:Preoperative use of ketorolac, prednisolone and nepafenac was effective in maintaining intraoperative mydriasis when compared with placebo.

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A Bisulfite-free Intraocular Epinephrine Solution

Cited by 14 publications

References 6 publications

Cytotoxicity of Lidocaine or Bupivacaine on Corneal Endothelial Cells in a Rabbit Model

Cytotoxicity of Lidocaine or Bupivacaine on Corneal Endothelial Cells in a Rabbit Model

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

Effect of preoperative use of topical prednisolone acetate, ketorolac tromethamine, nepafenac and placebo, on the maintenance of intraoperative mydriasis during cataract surgery: A randomized trial

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