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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. G S Brar MD Dilraj Grewal MD Rajeev Jain, MD SPS Grewal MD. GREWAL EYE INSTITUTE CHANDIGARH, INDIA. Financial Disclosures .

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G S Brar MD Dilraj Grewal MD Rajeev Jain, MD SPS Grewal MD

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  1. 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

  2. Financial Disclosures • None of the authors have any financial interest in this presentation

  3. 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

  4. 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

  5. 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.

  6. 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).

  7. 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

  8. Methods • GROUP 1: • RECEVIED 0.25% INTRACAMERAL PILOCARPINE • GROUP 2: RECEIVED NO INJECTION

  9. 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 (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.

  10. Results: Intraocular Pressure

  11. Results: Un-Corrected VA Decimal Scale

  12. 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

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

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