v

G S Brar MD

Dilraj Grewal MD

Rajeev Jain, MD

SPS Grewal MD

Postoperative IOP and Anterior Chamber

Inflammation Following Intracameral Injection

of Pilocarpine 0.25% at the End of

Phacoemulsification

GREWAL EYE INSTITUTECHANDIGARH, INDIA

v

Financial Disclosures

None of the authors have any financial interest in this

presentation

v

To evaluate the visual results and safety profile during the first 24 hours of Intracameral Pilocarpine Injection 0.25% following phacoemulsification with Intraocular Lens Implantation.

Purpose

Pilocarpine

v

Phacoemulsification has excellent results

Day care surgery and is performed under topical anesthesia,

The patient experiences practically an instant visual recovery

‘Wow’ effect : may be diminished if pupil remains dilated in early postoperative period

It is desirable to have minimal inflammation and IOP rise following surgery

Introduction

v

Pilocarpine.-The most widely-used miotic, producing a miosis in 10 to 15 minutes which

lasts several hours.

Unlike some other cholinergic drugs its vasodilatory effect is not marked.

Indications:

(a) Primary glaucoma.

(b) To reverse the effects of short-acting mydriatics.

Used in concentrations of 0.5 - 4 %

As its effects last 6 to 8 hours, it should be used at least three times a day in the

treatment of simple glaucoma, although in acute closed-angle glaucoma it may be

administered as frequently as once a minute.

Introduction: Pilocarpine

v

Introduction: Pilocarpine

Ocular Side-Effects

Impairment of Vision.-This is due to miosis and is increased by presence of lens opacities.

Accommodative Effects.-Ciliary spasm produces a temporary myopia

Iris Cysts.-The prolonged topical administrations of miotics, particularly long-acting anticholinesterases. Occurrence may be reduced by the simultaneous administration of adrenaline (1-2 %.)

Pain and Headache.-Due to ciliary spasm, usually temporary and relieved by salicylates.

Anterior Uveitis.-A faint flare is seen after the prolonged use and posterior synechiae may be formed.

Conjunctival Irritation.-Common with physostigmine, the long-continued use of which may lead to the development of a chronic follicular conjunctivitis and contact dermatitis.

Detachment of the Retina.-Avoid in a patient with a history of a retinal detachment.

Closed-angle Glaucoma.-Contraindicated in patients with narrow angles in whom an attack of angle closure may be precipitated.

Lens Opacities.-Anterior subcapsular opacities

Systemic Side Effects:

Occur particularly with the long-acting anticholinesterases and are the result of stimulation of the parasympathetic nervous system.

Nausea, vomiting, abdominal cramps, diarrhoea, bronchospasm, bradycardia, increased sweating and salivation, muscular-cramps, anxiety, tremor, and tension headaches may all occur.

Usually mild and disappear when the drug is discontinued. Severe symptoms may be treated with systemic atropine or pralidoxime (PAM).

v

Methods

Prospective analysis of 50 eyes of 42 patients.

25 eyes were randomized to receive intracameral injection of 0.25% pilocarpine at

end of surgery (Group 1) versus no injection in Group 2.

Postoperative uncorrected visual acuity, intraocular pressure (IOP) and anterior

chamber inflammation were scored at 2, 6 and 24 hours following surgery.

Anterior chamber inflammation was scored according to Hogan’s classification. IOP

measurement was done on the Goldman applanation tonometer

v

•GROUP 2: RECEIVED NO INJECTION•GROUP 1:

•RECEVIED 0.25% INTRACAMERAL PILOCARPINE

Methods

v

At 2 hours after surgery, there was no difference in IOP between Group 1 (14.75 +

2.2 mmHg) and Group 2 (15.1 + 2.4 mmHg).

Uncorrected visual acuity was significantly better (p< 0.01) in Group 1 (0.24 + 0.12)

as compared to Group 2 (0.41 + 0.14).

At 6 hours after surgery, IOP was significantly higher (p< 0.01) in Group 2 (22.37 +

3.75) as compared to Group 1 (16.66 + 2.2) and the uncorrected visual acuity was

significantly better in Group 1.

At 24 hours after surgery, there was no significant difference between the two

groups for any parameter.

There was no difference in the anterior chamber inflammation between the two

groups at any time duration upto 24 hours.

Results

v

Results: Intraocular Pressure

v

Results: Un-Corrected VA

.24

.15 .15

.41

.35

.16

.000

.125

.250

.375

.500

2 Hours 6 Hours 24 Hours

Control

Pilocarpine

Decimal Scale

v

Group 2 hours 6 hours 24 hours

Pilocarpine 1.3+ 0.3 2.1+ 0.2 1.4+ 0.2

No Pilocarpine 1.4+ 0.2 1.9+ 0.1 1.2+ 0.3

Results: Intraocular Inflammation Score

Intracameral

pilocarpine (0.25%) at

the end of

phacoemulsification

facilitates better IOP

control and

uncorrected visual

acuity on the day of

surgery.

Conclusions