Intracamerally injected mydriatic agents safer than standard eye drop regimen during cataract surgery performed in older patients.
The side effects of drugs are always concerns, no matter what the age or general health of patients. However, those concerns are amplified in older populations, particularly those who are at increased risk of cardiovascular events.
“Cataract is associated with old age and, as the population age, the demand for cataract surgery is increasing and will likely continue to increase. Additionally, elderlies are at an increased risk of developing multiple pathologies and are consequently polymedicated,” according to the investigators of a study in which the systemic exposure to the combination of tropicamide/phenylephrine after intracameral or topical administration before performing cataract surgery was evaluated.
This drug combination is considered the gold standard to establish stable mydriasis during cataract surgery with lens implantation. However, Jose Guell, MD, and colleagues pointed out that these drugs usually must be instilled multiple times intraoperatively, which may result in an overdose associated with increased risk of cardiovascular events and ocular surface toxicity, the latter of which can lead to keratopathy and decreased intraoperative visualization.
To avoid prolongation of the time to mydriasis preoperatively with administration of drugs in the surgical center or even at home where the patients are unsupervised, an intracameral fixed combination of mydriatic drugs and an anesthetic (ICMA) at the start of cataract surgery has been investigated and is considered safe and effective.
Dr. Guell et al. noted, “A particular benefit of intracameral mydriatics/anesthetic is the excellent bioavailability directly in the target tissues and the putative lower systemic absorption compared to [eye drop] formulations. The synergistic effect of the two mydriatic components also permits lower doses of each to be used, further limiting the local toxicity of these drugs.” Patients also have been reported to be more comfortable intraoperatively, with less preparatory and surgical time compared with use of drops.
Jose Guell, MD
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Dr. Guell is affiliated with the Autonomous University of Barcelona, Barcelona, Spain.