The safety of intracameral phenylephrine – A systematic review

Gowda, Akash; Jie, Wilson Wong Jun; Casson, Robert J.; Chan, Weng Onn

doi:10.1016/j.survophthal.2022.06.002

Cited by 5 publications

(5 citation statements)

References 45 publications

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“…We found 1 review article on the safety of IC phenylephrine that included only 3 of the references we have discussed earlier: 1 RCT that found statistically significant lower systolic blood pressure in the IC phenylephrine group when compared with topical administration, 1 case series that found no statistically significant elevation in blood pressure with IC phenylephrine administrated, and 1 case report of ventricular fibrillation. 10,42,47,49 Optimal Concentration of IC Phenylephrine for the Management of IFIS…”

Section: Evidence From Reviewmentioning

confidence: 99%

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

Chua,

Varshney,

Eke

2024

J Cataract Refract Surg

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Phenylephrine, a potent sympathomimetic, induces mydriasis via iris dilator muscle contraction. Intracameral (IC) phenylephrine has been successfully used in cataract surgery for initial mydriasis, maintaining mydriasis, and management of intraoperative floppy iris syndrome. Serious systemic adverse events (mainly cardiovascular) have been described with topical phenylephrine drops, but we found very little evidence of such adverse events associated with IC phenylephrine use. However, we suspect under-reporting of such adverse events, as they may instead be ascribed to anxiety, positioning, anaesthesia, etc. Optimal dosage/concentrations for IC phenylephrine use in different purposes have not been fully studied. In the absence of robust evidence, we suggest that lower but effective IC phenylephrine concentrations are used: a lower concentration (0.31%), in conjunction with an anticholinergic and lidocaine, may be used for initial mydriasis. For management of intraoperative floppy iris syndrome, 0.31% may be effective, though a higher concentration (1-1.25%) may be required.

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Section: Evidence From Reviewmentioning

confidence: 99%

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

Chua,

Varshney,

Eke

2024

J Cataract Refract Surg

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“…It also helps dilate the pupil by its direct relaxing action on sphincter pupillae. [ 7 10 11 ] Endothelial cell loss after the use of this drug during cataract surgery was comparable to a normal cataract surgery. [ 11 12 ] Lidocaine inhibits propagation of sensory nerve impulse to the brain and thus is helpful for relieving pain during topical phacoemulsification.…”

Section: Introductionmentioning

confidence: 98%

“…Since 2003, intracameral phenylephrine has been used as an alternative to topical mydriatics with a reportedly good safety profile. [ 5 6 7 ]…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular effects of diluted intracameral combination of 0.02% tropicamide, 0.31% phenylephrine, and 1% lidocaine during phacoemulsification to manage intraoperative miosis

Ghai,

Bali,

Sethi

et al. 2023

Taiwan Journal of Ophthalmology

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PURPOSE: Intracameral mydriatic agents (ICMAs) are replacing the conventional method of topical mydriasis for its fast action and no need for repeated instillation before cataract surgery. Its application for the management of intraoperative miosis needs to be studied with different doses of mydriatic agent. The objective of the study is to study cardiovascular effects of diluted intracameral combination of 0.02% tropicamide, 0.31% phenylephrine, and 1% lidocaine during phacoemulsification to manage intraoperative miosis. MATERIALS AND METHODS: The study was conducted at Mojiram Lions Eye Hospital Akbarpur Majra village, Palla Bakhtawarpur Road, Delhi, during the year 2021–2022 after taking approval from the Ethical Committee of the hospital. Patients undergoing cataract surgery who were not dilated adequately during the preoperative period or developed intraoperative miosis were managed by injecting diluted intracameral combination of 0.02% tropicamide, 0.31% phenylephrine, and 1% lidocaine (phenocaine plus). 0.5 ml of phenocaine plus was diluted with 1.5 ml of ringer lactate solution and 0.50 ml of this solution was injected intracameral and its effect on pulse rate, blood pressure (BP), and oxygen saturation were monitored continuously on pulse oximeter. RESULTS: There was no statistically significant effect of diluted ICMA (Phenocaine Plus) on diastolic BP and oxygen saturation. However, systolic BP showed a little change from mean of 133.78 (standard deviation [SD] =16.04) mmHg to 133.92 (SD = 15.33) mmHg which was statistically significant but clinically not significant. Pulse rate increased slightly from mean 76.46 per minutes (SD = 15.14) to 79.40 (SD = 14.95) at 10 s and 76.49 (SD = 15.15) at 60 s. The difference was again statistically significant but clinically insignificant. CONCLUSION: Low concentration of intracameral combination of 0.02% tropicamide, 0.31% phenylephrine, and 1% lidocaine is a very safe and effective method for the management of intraoperative miosis.

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“…Phenylephrine is a synthetic, sympathomimetic agent with predominantly alpha adrenoceptor stimulant activity. It has vasoconstrictor, decongestant, and weak bronchodilator activities [2] . Vasopressin increases water reabsorption by improving the permeability of epithelial cells of the renal collecting duct, produces an antidiuretic effect, and also constricts peripheral blood vessels [3] .…”

Section: Introductionmentioning

confidence: 99%

A study on the identification of types of cerebral edema by using multi-parametric imaging system

Zhang¹,

Li²,

Qi³

et al. 2022

Optics in Health Care and Biomedical Optics XII

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Cerebral edema is a potentially fatal disorder and divided into several types. The accurately identifying the type of cerebral edema is vital for the precise treatment. Previous studies have been devoted the multi-model parameters to access the feature cerebral edema. However, few research focused on the models to distinguish the types of cerebral edema. Here, a multi-parameter joint imaging system was developed, which combined laser speckle contrast imaging system (LSCI) and intrinsic optical signals imaging system (IOS). Several parameters such as relative cerebral blood flow (rCBF), concentration changes of oxy-hemoglobin (HbO), deoxy-hemoglobin (HbR), and blood oxygen saturation (sO2) were recorded at the same region of interest (ROI). Vasogenic and cytotoxic cerebral edema models were induced by phenylephrine hydrochloride and vasopressin, respectively. The mice were randomly assigned to 2 groups and 10 individuals in each group. After drug injection, the parameters were collected every 20 minutes within 2 h in vivo. The rCBF in both groups increased gradually within 2 hours throughout the whole process, but the rCBF in the vasogenic group grew substantially faster than it in the cytotoxic group within the first 80 minutes. In the vasogenic group, the concentration changes of HbO and HbR were more pronounced. The data was analyzed by the t-test of an independent sample, and there were significant differences between the parameters of the two types of cerebral edema. It has potential for achieving a classification of cerebral edema.

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The safety of intracameral phenylephrine – A systematic review

Cited by 5 publications

References 45 publications

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

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

Cardiovascular effects of diluted intracameral combination of 0.02% tropicamide, 0.31% phenylephrine, and 1% lidocaine during phacoemulsification to manage intraoperative miosis

A study on the identification of types of cerebral edema by using multi-parametric imaging system

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