Correlation of Epinephrine Use and Macular Edema in Aphakic Glaucomatous Eyes

Effect of intracameral epinephrine use on macular thickness after uneventful phacoemulsification

“…The correlation between topical epinephrine use and macular edema in aphakic eyes with glaucoma is well known, and there have been many studies of this relationship since 1970. [1][2][3][4] Although many advances have been made in cataract surgery, its success depends on adequate pupil dilation to ensure good visualization of ocular structures posterior to the iris, especially the lens. Pupil dilation is maintained by preoperative topical mydriatic eyedrops and to some extent by retrobulbar, peribulbar, or sub-Tenon anesthesia.…”

“…Onset of symptoms ranges from a few days after commencement of epinephrine therapy to several months thereafter. 3,4 Cystoid macular edema is a significant cause of decreased vision after cataract surgery. 5,6 The accompanying intraretinal fluid accumulation is associated with retinal thickening and cyst formation, which can be identified on biomicroscopy, optical coherence tomography (OCT), retinal thickness analysis, or fluorescein angiography.…”

Mydriatic insert and intracameral injections compared with mydriatic eyedrops in cataract surgery: Controlled studies

“…97,106,107,114 Retina The retinal effects of intracameral mydriatic injections and mydriatic eyedrops were compared in 2 RCTs using OCT. 68,79 Retinal evaluation was justified by the association of topical epinephrine with cystoid macular edema (CME) in aphakic eyes. [115][116][117][118] Although usually presenting as a reversible change, epinephrineassociated maculopathy may evolve to CME, which is a significant cause of decreased vision after cataract surgery. 68,119,120 Optical coherence tomography is sensitive enough to detect subclinical changes in macular thickness during the postoperative period, 79,119,121 and temporary increased macular thickness was observed with OCT after uneventful cataract surgery.…”

Intracameral Mydriatics in Cataract Surgery

“…Many investigators have reported an association between the use of epinephrine and macular edema in glaucoma patients (Kolker and Becker 1968;Thomas, Gragoudas et al 1978;Classe 1980;Mehelas, Kollarits et al 1982), particularly in aphakia, but also in pseudophakia, a condition known as epinephrine maculopathy (Miyake, Shirasawa et al 1989). It has been hypothesized that epinephrine maculopathy is induced by a mechanism involving prostaglandins or other eicosanoids and not directly by epinephrine (Miyake, Shirasawa et al 1989).…”