G S Brar MD

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Postoperative IOP and Anterior Chamber
Inflammation Following Intracameral Injection of
Pilocarpine 0.25 at the End of
Phacoemulsification
G S Brar MD Dilraj Grewal MD Rajeev Jain, MD SPS
Grewal MD
GREWAL EYE INSTITUTE CHANDIGARH, INDIA
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Financial Disclosures

• None of the authors have any financial interest
  in this presentation

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Purpose

• 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.

Pilocarpine
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Introduction

• 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

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Introduction Pilocarpine

• 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.

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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).

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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 Hogans classification. IOP
  measurement was done on the Goldman applanation
  tonometer

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Methods

• GROUP 1
• RECEVIED 0.25 INTRACAMERAL PILOCARPINE

• GROUP 2 RECEIVED NO INJECTION

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Results

• 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 (plt 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 (plt 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.

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Results Intraocular Pressure
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Results Un-Corrected VA
Decimal Scale
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Results Intraocular Inflammation Score
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Conclusions

• Intracameral pilocarpine (0.25) at the end of
  phacoemulsification facilitates better IOP
  control and uncorrected visual acuity on the day
  of surgery.