Topical naproxen sodium for inhibition of miosis during cataract surgery. Prospective, randomized clinical trials

Papa, V; Russo, Simona; Russo, P.; Bella, Alessandro Di; Santocono, Marcello; Milazzo, Giovanni

doi:10.1038/sj.eye.6700124

Cited by 17 publications

(12 citation statements)

References 19 publications

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“…To perform a safe operation the pupil needs not only to be dilated preoperatively but preferably to remain dilated throughout the procedure. Different techniques have been suggested for the maintenance of mydriasis (Duffin et al 1982), including preoperative diclofenac (Antcliff & Trew 1997), naproxen (Papa et al 2002), viscous phenylephrine hydrochloride (Duffin et al 1983a) or intraoperative intracameral epinephrine, either in the irrigation solution (Liou & Yang 1998) or as a single bolus dose (Liou & Chen 2001).…”

Section: Introductionmentioning

confidence: 99%

Redilatation with intracameral mydriatics in phacoemulsification surgery

Bäckström

Behndig

2006

Acta Ophthalmologica Scandinavica

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ABSTRACT.Purpose: To determine whether intracameral mydriatics can redilate pupils that contract during phacoemulsification cataract surgery. Methods: A total of 80 patients were included in this prospective, randomized, double-blind study performed at Ö rnsko¨ldsviks Hospital Eye Clinic. Of these, 60 patients had 0.6 mg/ml of epinephrine added to the balanced salt solution (BSS) used for irrigation and 20 patients did not. The patients in each group were randomized and given either an intracameral mydriatics (ICM) solution or placebo intracamerally after phacoemulsification and cortex cleaning. The pupil size was registered preoperatively, after cortex cleaning, 30 seconds after study injection, 2 mins after study injection and the day after surgery. Results: No clinically relevant differences were found preoperatively. In the epinephrine material a significantly longer operation time (p = 0.023) and more procedures requiring Vision Blue TM and Kelman-type tip in the placebo group might indicate diversity in the grade of cataract. There was a greater degree of contraction in the absence of epinephrine in the irrigation solution (2.3 ± 1.0 mm in the ICM group and 3.2 ± 0.7 mm in the placebo group) compared to in the presence of epinephrine. With no epinephrine ICM significantly redilated the pupils at 30 seconds (p £ 0.001) as well as at 2 mins (p = 0.015). Conclusion: We have shown that in cases with an intraoperative pupil contraction, ICM is effective in redilating the pupil. Insufficient adrenergic stimulation of the pupil dilator appears to be a major factor causing intraoperative pupil contraction during phacoemulsification cataract surgery.

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Section: Introductionmentioning

confidence: 99%

Redilatation with intracameral mydriatics in phacoemulsification surgery

Bäckström

Behndig

2006

Acta Ophthalmologica Scandinavica

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“…During cataract surgery, onset of miosis linked to the effect on the iris sphincter of PGs and other mediators is effectively inhibited by diclofenac when administered preoperatively [11,25,26].…”

Section: Miosis During Cataract Surgerymentioning

confidence: 99%

“…In addition, the vasodilatory effect of PG induces hyperemia in the conjunctiva. PGs also cause the iris sphincter to constrict (miosis) [11]. The pharmacologic effect of most NSAIDs is based on an inhibition of the cyclooxygenase coenzyme (COX-1 and -2) activity on arachidonic acid, which subsequently inhibits the formation of PGs.…”

Section: Anti-inflammatory Effectmentioning

confidence: 99%

Diclofenac sodium 0.1% ophthalmic solution: update on pharmacodynamics, clinical interest and safety profile

Bodaghi

2008

Expert Review of Ophthalmology

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Diclofenac sodium 0.1% ophthalmic solution has a long, well-proven track record as a potent, efficacious, topical, ocular anti-inflammatory agent, especially in the control of miosis during surgery, postsurgical inflammation of the anterior segment, cystoid macular edema and inflammation owing to noninfectious conjunctivitis such as allergic conjunctivitis. Owing to its analgesic properties, it is also widely used for short-duration treatment in pain associated with photorefractive keratectomy and corneal erosion. Therefore, it has been approved by health authorities for a wide range of indications, depending on each country. It has been shown to be at least as effective as other nonsteroidal anti-inflammatory drugs and corticosteroids. Diclofenac is a well-tolerated product and the few serious corneal adverse events that do occur could be avoided by good prescriptive practice and careful follow-up of patients at-risk. This review summarizes the available data on pharmacokinetics and pharmacodynamics, as well as the efficacy, safety and regulatory aspects related to diclofenac.

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“…Conversely, adequate and stable dilation reduced the risk for iris prolapse and engagement. 3 Preventing Intraoperative Miosis with Epinephrine The maintenance of adequate mydriasis during the entire cataract surgery procedure is of paramount importance, and various techniques have been proposed, 78 including mechanical devices (eg, iris retractors), 126 preoperative nonsteroidal antiinflammatory drugs, 23,127,128 viscous phenylephrine, 20 and intraoperative epinephrine. 19,22,85,129 Several studies have shown that epinephrine is required to oppose intraoperative miosis and maintain stable mydriasis when pupils are initially dilated with mydriatic eyedrops.…”

Section: Role In Rescue Dilationmentioning

confidence: 99%