Efficacy of the intracamerally administered mydriatics for cataract surgery in patients with primary open-angle glaucoma

Abstract

Purpose To compare Mydrane®, mydriatic eye drops, and Mydriasert® in terms of pupil site stability, surgical time, visual field, and anterior chamber configuration modifications among patients with primary open-angle glaucoma (POAG) during cataract extraction surgery. Methods Retrospective analysis of sixty patients with POAG and cataract who underwent elective cataract extraction. All patients underwent routine ophthalmic examinations, including automatic visual field examination, anterior chamber configuration, specular microscopy, and arterial blood pressure measurement prior to surgery, and 24 h and 30 days postoperatively. All cataract surgeries were video-recorded and all measurements were performed using a media player. Patients divided into groups 1, 2, and 3 (n = 20 in each group) received topical mydriatic eye drops, Mydriasert®, and an intracameral injection of Mydrane®, respectively, immediately after the first incision. Results The mean change in pupil size from just before capsulorhexis to the end of surgery was 0.43 ± 0.09, 0.42 ± 0.08, and 0.36 ± 0.02 mm in groups 1, 2, and 3, respectively. The mean surgery duration was similar among all the groups. The baseline main cell density slightly decreased at 24 h and remained stable for 30 days postoperatively. The mean deviation and pattern standard deviation remained stable at 1 month after surgery. At 24 h after surgery, the nasal irido-corneal angle, temporal-iridocorneal angle, and anterior chamber depth increased compared with the baseline, remaining stable for 30 days after surgery. Conclusions Mydrane® produced adequate and stable mydriasis as effectively as produced by Mydriasert® and topical eye drops.

Intracameral phenylephrine for surgical mydriasis and intraoperative floppy-iris syndrome: systemic adverse effects and optimal dose

“…25 In the absence of robust evidence for the safe concentration IC phenylephrine, a total dose of 0.62 to 9 mg seems to be safe when administered to adult patients as it has not been associated with any reported SAEs in pRCTs. 35,36,41,42,48 Although no significant changes in heart rate and blood pressure were reported with IC phenylephrine in pediatric cases (ages ranged from 1 month to 10 years, a total dose of 0.078 to 0.31 mg), we were unable to make any recommendation as the number of patients studied was small (n = 66). 44,45…”

“…We found 4 comparative studies (not pRCTs) reviewing the SAEs of IC phenylephrine (Supplemental Table 3, available at http://links.lww.com/JRS/B7). [38][39][40][41] A total of 393 eyes received IC phenylephrine; the total dose ranged from 0.62 to 7.5 mg; and compared with eyes that received topical phenylephrine, the total dose ranged from 1.67 to 11.1 mg. 38,41 There were no significant SAEs associated with IC phenylephrine administration reported other than local ocular complications in these studies.…”

Pain experience in patients undergoing topical anesthesia alone versus topical plus intracameral anesthesia during cataract surgery

“…11 In 2015, Mydrane®, the first ready-to-use and preservative-free intracameral drug was approved for use in many European countries, including Italy. 12 To induce mydriasis and intraocular anesthesia, Mydrane® is injected into the anterior chamber at the beginning of cataract surgery (just after the main incision creation). Notably, a 0.2-mL dose contains 0.62 mg of phenylephrine, 0.04 mg of tropicamide, and 2 mg of lidocaine hydrochloride.…”

Effectiveness of a Standardized Combination of Intracameral Mydriatics and Anaesthetic on Mydriasis during Cataract Surgery with Coexisting Diseases

“…Both ophthalmic diseases such as glaucoma, as well as systemic comorbidities, like diabetes mellitus and pseudoexfoliation syndrome (PXF), and the use of non-selective α1 adrenergic receptor antagonists (α1-blockers) for treating prostatic hyperplasia or arterial hypertension, may pose challenges in dilating the pupil [11].…”

“…In 2015, a standardized combination of mydriatics (0.02% tropicamide, 0.31% phenylephrine) and an anesthetic (1% lidocaine) [25] (SCIMA)-Mydrane-was introduced in the form of intracameral injections to obtain mydriasis during cataract surgery. One 0.2 mL dose contains 0.04 mg of tropicamide, 0.62 mg of phenylephrine hydrochloride, and 2 mg of lidocaine hydrochloride [11,26]. The mydriatic effect of those combined substances in one solution is greater than that of any of these agents alone [27].…”