Prospective Review of the Benefits

1
Prospective Review of the Benefits Safety of
Intracameral Phenylephrine Use During
Phacoemlusification

• ASCRS SAN DIEGO 2007
• A Kumar R B Packard
• King Edward VII Hospital, Windsor UK

2
Background

• Impaired visualisation through a small pupil can
  increase the chance of complications during
  cataract surgery
• Causes for poorly dilated pupils and /or miosis
  during surgery include diabetes, systemic drugs
  Tamsulosin and pseudoexfloliation
• Iris hooks1, spincterectomy2 and pupil expanding
  devices1,3 are routinely used in such cases

1. Akman A, Yilmaz G, Oto S, Akova YA. Comparison
of various pupil dilatation methods for
phacoemulsification in eyes with a small pupil
secondary to pseudoexfoliation.Ophthalmology.
2004 Sep111(9)1693-8 2. Fine IH, Pupilloplasty
for small pupil phacoemulsification J Cataract
Refract Surg 1994 Mar20(2)192-6. 3. Kershner RM
Managemnet of the small pupil for clear corneal
cataract surger. J Cataract Refract Surg2002 Oct
28(10) 1826-31
3
Objective

• To evaluate the benefits and systemic effects
  of intracameral phenylephrine (ICP) use in small
  pupil cataract surgery

4
Methods

• Data Collection
• -Demographics
• -Cause of small pupil,
• -Change in pupil size / area,
• -Grade of surgeon surgeon score
• -Systemic parameters (BP, pulse and O2
  saturation) prior to ICP use, 5mins and 30
  mins after ICP.
• Exclusion criteria
• -Posterior synechiae iris trauma

5
Results

• Prospective review
• Over 3 months
• Total number of cases 15
• Males 9
• Mean Age 67.6 years
• (range 61 - 74 yrs)

Grade of surgeon Consultants 8
cases Trainees 7 cases
6
Results
Mean increase in pupil size 3.8 mm Pupillary
area increased by 5 fold in 89 of cases
7
Progressive enlargement of the pupil after
intracameral phenylephrine

• Preparation of intracameral phenylephrine
• Preservative-free phenylephrine hydrochloride
  2.5 minims mixed
• with balanced salt solution.
• Dilution 0.25 ml of phenlyephrine with 1.0 ml
  balanced salt solution

A Gurbaxani and R Packard Intracameral
phenylepherine to prevent floppy iris syndrome
during cataract surgery in patients on tamsulosin
Eye 2007 Mar21(3)331-2.
8
Results

• No statistically significant changes were noted
  in blood pressure, pulse and oxygen saturation
  levels after ICP injection
• Subjective surgical confidence score showed 4
  fold increase in performing the procedure in 73
  of cases
• One case of capsular rupture was noted
• No post-operative complications were noted

9
Conclusion

• ICP is an effective method for pupil dilatation
  in small pupil cataract surgery
• Technique is easy to perform
• Useful tool in otherwise challenging cases