Efficacy and safety of intraoperative intracameral mydriasis in manual small incision cataract surgery - A randomized controlled trial

Ajay, K; Saranya, S; Sundaresh, Divya Dabir; Hithashree, HR; Hemalatha, B C; Krishnaswamy, Malavika; Shetty, Sathyendranath B.

doi:10.4103/ijo.ijo_262_17

Cited by 10 publications

(6 citation statements)

References 20 publications

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“…Ajay et al . [ 8 ] reported similar pattern of dilation in MSICS with intracameral mydriatics in the study done in 2017. This was in contrast to the study by Gupta et al .…”

Section: Discussionmentioning

confidence: 65%

“…[ 9 ] in 1999 and Ajay et al . [ 8 ] in 2017 concluded that use of IC anesthetic increased patient’s comfort, especially during IOL implantation and led to greater surgeon’s satisfaction. Epinephrine is a known risk factor for pseudophakic cystoid macular oedema, but intracameral epinephrine at a concentration of 0.2 mg/mL or lesser (1:5000) has been shown as not to be associated with increased risk of central macular oedema.…”

Section: Discussionmentioning

confidence: 99%

“…[ 7 ] Peribulbar injection of lignocaine hydrochloride has been the method of choice for preoperative anesthesia and analgesia till date. [ 8 ] But procedure-related complications like pain, perforation of globe, retinal detachment or vitreous hemorrhage have been reported. It can also rarely cause retinal vascular occlusion, retrobulbar hemorrhage, strabismus, ptosis, optic nerve damage, and even cardiac or respiratory arrest.…”

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confidence: 99%

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Evaluation of efficacy of intracameral lidocaine and tropicamide injection in manual small-incision cataract surgery

Bhat¹,

Wadgaonkar²,

Undre³

et al. 2022

Indian Journal of Ophthalmology

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Purpose: The study was conducted to evaluate efficacy of intracameral lidocaine hydrochloride 1% and tropicamide injection 0.02% for anaesthesia and mydriasis in manual small-incision cataract surgery (MSICS) and to report any adverse drug reaction. Methods: This was a randomized, prospective, observational study on 32 participants that took place from October 2021 to March 2022 (6 months). Patients between age group 40–75 year with nuclear sclerosis cataract and pupil diameter >6 mm in preoperative evaluation were included in the study. Patients with pseudoexfoliation, rigid pupil, senile miosis, history of uveitis, ocular trauma, recent ocular infections, with known allergy to tropicamide, all types of glaucoma were excluded from the study. Results: Thirty-two eyes with nuclear sclerosis cataract who underwent MSICS were studied. Fixed dose combination of 2 ml phenyl epinephrine (0.31%), tropicamide (0.02%), and lidocaine (1%) intracamerally was used for mydriasis and analgesia. More than 7 mm pupillary dilatation was achieved within 20 seconds of injection in 29 cases (90.6%). Mild pain and discomfort was noted in 12 cases (37.5%). Postoperative day 1 unaided visual acuity was in the range of 6/18–6/12 for all patients and grade 1 iritis was seen in 7 cases (21.8%) which was self-limiting. No adverse event like corneal decompensation or TASS were noted. Conclusion: Thus, Intracameral injection of mydriatic provides rapid and sustainable mydriasis and analgesia for manual SICS.

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“…Ajay et al . [ 8 ] reported similar pattern of dilation in MSICS with intracameral mydriatics in the study done in 2017. This was in contrast to the study by Gupta et al .…”

Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Evaluation of efficacy of intracameral lidocaine and tropicamide injection in manual small-incision cataract surgery

Bhat¹,

Wadgaonkar²,

Undre³

et al. 2022

Indian Journal of Ophthalmology

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“…K Ajay found that after achieving maximal dilatation with topical mydriatic, no significant change in pupillary size was noted after a peribulbar block. [ 21 ] Udai Devgan found that single most important predictor of good vision and a clear cornea postoperatively is the total amount of phaco energy delivered into the eye. [ 10 ] In our study, effective phaco time in Group A was 3.89 ± 2.44 s, Group B was 3.45 ± 2.51 s, and Group C was 3.31 ± 2.33 s with no statistically significant difference ( P = 0.462).…”

Section: Discussionmentioning

confidence: 99%

Comparative analysis of endothelial cell loss following phacoemulsification in pupils of different sizes

Maggon

Bhattacharjee

Shankar

et al. 2017

Indian J Ophthalmol

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Purpose:To compare Endothelial cell(EC) loss following Phacoemulsification (PKE) in pupils of different sizes.Methods:A prospective double masked observational study in which a total of 150 eyes of 150 patients between 50 & 70 years of age with senile cataract of nuclear sclerosis grade II were enrolled. Patients were allocated into three groups of 50 eyes each in Group A (pupil size <5 mm), Group B (pupil size 5–7 mm) and Group C (pupil size >7 mm). Pupillary size was measured by determining the height of slit on slit-lamp biomicroscope examination. PKE was done by the same expert surgeon using vertical chop technique and a foldable intraocular lens was implanted in the capsular bag. Corneal EC count and pachymetry were performed twice and average of 2 readings was taken for the purpose of this study. Measurements were taken preoperatively and postoperatively on day 1, day 7 and day 30.Results:The mean EC count loss on postoperative day 1 in Group A was 19.45%, Group B 14.89%, Group C 10.19% with statistical significant difference between Group A and Group B, as also Group A and Group C. The difference was not significant between Group B and Group C, though there was a fall in EC count in Group C as well. Increase in corneal thickness on postoperative day 1 in group A was 5.43%, Group B 3.55%, Group C 2.14% with statistical significant difference between Group A and Group B, as also Group A and Group C with no difference in Group B and Group C.Conclusion:PKE done in eyes with maximal pupillary dilatation of <5 mm causes a greater EC loss and results in thicker corneas postoperatively as compared to eyes with pupillary dilatation of >5 mm at the end of one month.

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“…Intracameral 0.001% or 1:100,000 epinephrine hydrochloride has been reported to be a safe intraoperative mydriatic that can be used to manage pupillary constriction without causing any adverse effects on the corneal endothelium. [ 58 - 60 ]…”

Section: Role Of Intracameral Drugsmentioning

confidence: 99%

Corneal endothelial protection during manual small-incision cataract surgery

Singh

Mishra

Sinha

et al. 2022

Indian Journal of Ophthalmology

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Cataract causes bilateral blindness in 20 million people globally, the vast majority of whom live in developing countries. Manual small-incision cataract surgery (MSICS) has emerged as an efficient and economical alternative to phacoemulsification, giving comparable results in terms of final visual gain. One of the important determinants of postoperative visual gain is the status of the corneal endothelium. Multiple factors such as corneal distortion, irrigation solution turbulence, mechanical trauma by instruments, nuclear fragments, intraocular lens contact, and free oxygen radicals, all have been implicated in causing corneal damage during cataract surgery. MSICS with posterior chamber intraocular lens implantation has been reported to cause an endothelial cell loss of 15.83%, which is comparable with other modes of cataract surgery like extracapsular cataract extraction and phacoemulsification. Thorough preoperative assessment of endothelial status and taking necessary steps for endothelial protection during surgery can decrease the endothelial cell loss and overall burden of pseudophakic bullous keratopathy. In addition to surgical techniques, the type of irrigating solutions, ocular viscoelastic devices, intracameral dyes, and drugs all affect the endothelial cell status. This review presents a summary of available literature on the protection of endothelial cells during different steps of MSICS. This is especially relevant for developing countries where large-scale MSICS cataract surgeries are performed to decrease the cataract blindness burden.

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Efficacy and safety of intraoperative intracameral mydriasis in manual small incision cataract surgery - A randomized controlled trial

Cited by 10 publications

References 20 publications

Evaluation of efficacy of intracameral lidocaine and tropicamide injection in manual small-incision cataract surgery

Evaluation of efficacy of intracameral lidocaine and tropicamide injection in manual small-incision cataract surgery

Comparative analysis of endothelial cell loss following phacoemulsification in pupils of different sizes

Corneal endothelial protection during manual small-incision cataract surgery

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