Intraoperative mydriasis by intracameral injection of mydriatic eye drops: in vivo efficacy and in vitro safety studies.

Abstract

BACKGROUND:

This study investigated the efficacy and safety of intracameral injection of commercially available eye drops containing 0.5% tropicamide and 0.5% phenylephrine hydrochloride (Mydrin-P, Santen Pharmaceutical, Osaka, Japan).

DESIGN:

In vitro experiment and prospective clinical study at a private hospital.

PARTICIPANTS AND SAMPLES:

Mydrin-P was applied to confluent cultured human corneal endothelial cells, and the cellular morphology was examined. Clinical study subjects were 65 eyes of 65 patients that underwent phaco-emulsification and aspiration with intraocular lens implantation and received intracameral injection of Mydrin-P for poor mydriasis after preoperative topical instillation of mydriatics (intraocular mydriasis group; with five subgroups based on cause: diabetes, pseudo-exfoliation, post-surgery, uveitis, unknown). Controls, comprising 39 eyes of 39 patients, were not injected with Mydrin-P.

METHODS:

The ratio of pupillary diameter to corneal diameter was determined before and after injection of Mydrin-P. Corneal endothelial density was measured preoperatively and 3 months and 1 year postoperatively.

MAIN OUTCOME MEASURES:

Pupillary diameter and corneal endothelial density.

RESULTS:

Human corneal endothelial cell morphology was unaltered after Mydrin-P injection. The mean ratio of the pupillary diameter to corneal diameter increased in the intraocular mydriasis group (before: 54.2 ± 4.8%, after: 58.4 ± 6.6%; P < 0.001) and in the diabetes and unknown subgroups. The corneal endothelial cell density reduction rate 3 months and 1 year after surgery was not significantly different between the intraocular mydriasis group and controls.

CONCLUSION:

Intracameral injection of Mydrin-P appears to be effective and safe for dilating the pupil in cases with poor mydriasis after preoperative instillation of mydriatics.

• Authors: Yosai Mori, Takashi Miyai, Fumie Kagaya, Nobuyuki Nagai, Yasuhiro Osakabe, Kazunori Miyata, Shiro Amano
• Journal: Clinical & experimental ophthalmology (Clin Exp Ophthalmol) Vol. 39 Issue 5 Pg. 456-61 (Jul 2011) ISSN: 1442-9071 [Electronic] Australia
• PMID: 21070540 (Publication Type: Journal Article)
• Copyright: © 2011 The Authors. Clinical and Experimental Ophthalmology © 2011 Royal Australian and New Zealand College of Ophthalmologists.

Chemical References

• Mydriatics
• Phenylephrine
• Tropicamide

Topics

• Aged
• Anterior Chamber
• Cell Count
• Cells, Cultured
• Drug Therapy, Combination
• Endothelium, Corneal (cytology, drug effects)
• Female
• Humans
• Injections, Intraocular
• Intraoperative Care
• Lens Implantation, Intraocular
• Male
• Mydriatics (administration & dosage, adverse effects)
• Phacoemulsification
• Phenylephrine (administration & dosage, adverse effects)
• Prospective Studies
• Pupil (drug effects)
• Treatment Outcome
• Tropicamide (administration & dosage, adverse effects)