Systemic exposure to intracameral vs topical mydriatic agents: in cataract surgery

Jose Guell,1 Anders Behndig,2 Uwe Pleyer,3 Stéphane Jaulerry,4 Pascal Rozot,5 Pierre-Jean Pisella,6 Pierre-Yves Robert,7 Ines Lanzl,8 Sayeh Pourjavan,9 Carlos Aguiar,10 Joaquin Fernandez,11 Gunther Grabner,12 Rita Mencucci,13 Frédéric Chiambaretta,14 Marc Labetoulle1...

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Autores principales:	Guell J, Behndig A, Pleyer U, Jaulerry S, Rozot P, Pisella PJ, Robert PY, Lanzl I, Pourjavan S, Aguiar C, Fernandez J, Grabner G, Mencucci R, Chiambaretta F, Labetoulle M
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2019
Materias:	cataract surgery intracameral mydriasis topical mydriasis systemic influence cardiovascular safety Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/0ad0ca44d77b4bd39647b4d62d923e1a
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spelling	oai:doaj.org-article:0ad0ca44d77b4bd39647b4d62d923e1a2021-12-02T02:50:48ZSystemic exposure to intracameral vs topical mydriatic agents: in cataract surgery1177-5483https://doaj.org/article/0ad0ca44d77b4bd39647b4d62d923e1a2019-05-01T00:00:00Zhttps://www.dovepress.com/systemic-exposure-to-intracameral-vs-topical-mydriatic-agents-in-catar-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Jose Guell,1 Anders Behndig,2 Uwe Pleyer,3 Stéphane Jaulerry,4 Pascal Rozot,5 Pierre-Jean Pisella,6 Pierre-Yves Robert,7 Ines Lanzl,8 Sayeh Pourjavan,9 Carlos Aguiar,10 Joaquin Fernandez,11 Gunther Grabner,12 Rita Mencucci,13 Frédéric Chiambaretta,14 Marc Labetoulle15 On behalf of the Intracameral Mydrane (ICMA) and Ethics Group 1Cornea and Refractive Surgery Unit, Instituto de Microcirugía Ocular, Barcelona, Spain; 2Department of Clinical Science/Ophthalmology, Umeå University Hospital, Umeå, Sweden; 3Universitäts-Augenklinik, Charité Campus Virchow-Klinik, Berlin, Germany; 4Centre Hospitalier de Bigorre, Tarbes, France; 5Clinique Monticelli, Marseille, France; 6Hôpital Bretonneau, CHRU de Tours, Tours, France; 7Hôpital Dupuytren, CHU de Limoges, Limoges, France; 8Chiemsee Augen Tagesklinik, Prien, Germany; 9Cliniques Universitaires Saint-Luc, Bruxelles, Belgium; 10Hospital de Santo Antonio, Porto, Portugal; 11Hospital Torrecárdenas, Almeria, Spain; 12Universitätsklinik Für Augenheilkunde Und Optometrie, Der Paracelsus, Austria; 13AOU Careggi, Clinica Oculistica, Università Degli Studi di Firenze, Firenze, Italy; 14Hôpital Gabriel Montpied, CHU de Clermont-Ferrand, Clermont-Ferrand, France; 15Hôpital Bicêtre, Université Paris Sud, Paris, France Objective: The objective of this study was to compare systemic exposure to tropicamide/phenylephrine following intracameral or topical administration before cataract surgery. Patients and methods: Mydriatics exposure was calculated in patients randomized to intracameral fixed combination of mydriatics and anesthetic ([ICMA]: tropicamide 0.02%, phenylephrine 0.31%, and lidocaine 1%, N=271) or mydriatic eye drops ([EDs]: tropicamide 0.5% and phenylephrine 10%, N=283). Additional doses were permitted if required. Mydriatic plasma levels were determined by mass spectrometric HPLC in 15 patients per group before and after administration.Results: Most ICMA patients (73.6%) received a single dose (200 µL) representing an exposure to tropicamide of 0.04 mg and phenylephrine of 0.62 mg. None of these patients received additional mydriatics. In the control group (three administrations), the exposure was 0.45 (11.3-fold higher than ICMA) and 10.2 (16.5-fold higher) mg. When additional ED was used in this group (9.2% of patients), it was 37.5-fold higher for tropicamide (10 drops, 1.5 mg) and 54.8-fold higher for phenylephrine (10 drops, 34 mg) than the recommended ICMA dose. Tropicamide plasma levels were not detectable at any time point in ICMA patients while it was detectable in all ED patients at 12 and 30 minutes. Phenylephrine was detectable in 14.3% of ICMA patients compared to all ED patients at least at one time point. More ED patients experienced a meaningful increase in blood pressure and/or heart rate (11.2% vs 6.0% of ICMA patients; P=0.03).Conclusion: Systemic exposure to tropicamide/phenylephrine was lower and cardiovascular (CV) effects were less frequent with ICMA. This could be of particular significance in patients at CV risk. Keywords: cataract surgery, intracameral mydriasis, topical mydriasis, systemic influence, cardiovascular safety  Guell JBehndig APleyer UJaulerry SRozot PPisella PJRobert PYLanzl IPourjavan SAguiar CFernandez JGrabner GMencucci RChiambaretta FLabetoulle MDove Medical Pressarticlecataract surgeryintracameral mydriasistopical mydriasissystemic influencecardiovascular safetyOphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 13, Pp 811-819 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	cataract surgery intracameral mydriasis topical mydriasis systemic influence cardiovascular safety Ophthalmology RE1-994
spellingShingle	cataract surgery intracameral mydriasis topical mydriasis systemic influence cardiovascular safety Ophthalmology RE1-994 Guell J Behndig A Pleyer U Jaulerry S Rozot P Pisella PJ Robert PY Lanzl I Pourjavan S Aguiar C Fernandez J Grabner G Mencucci R Chiambaretta F Labetoulle M Systemic exposure to intracameral vs topical mydriatic agents: in cataract surgery
description	Jose Guell,1 Anders Behndig,2 Uwe Pleyer,3 Stéphane Jaulerry,4 Pascal Rozot,5 Pierre-Jean Pisella,6 Pierre-Yves Robert,7 Ines Lanzl,8 Sayeh Pourjavan,9 Carlos Aguiar,10 Joaquin Fernandez,11 Gunther Grabner,12 Rita Mencucci,13 Frédéric Chiambaretta,14 Marc Labetoulle15 On behalf of the Intracameral Mydrane (ICMA) and Ethics Group 1Cornea and Refractive Surgery Unit, Instituto de Microcirugía Ocular, Barcelona, Spain; 2Department of Clinical Science/Ophthalmology, Umeå University Hospital, Umeå, Sweden; 3Universitäts-Augenklinik, Charité Campus Virchow-Klinik, Berlin, Germany; 4Centre Hospitalier de Bigorre, Tarbes, France; 5Clinique Monticelli, Marseille, France; 6Hôpital Bretonneau, CHRU de Tours, Tours, France; 7Hôpital Dupuytren, CHU de Limoges, Limoges, France; 8Chiemsee Augen Tagesklinik, Prien, Germany; 9Cliniques Universitaires Saint-Luc, Bruxelles, Belgium; 10Hospital de Santo Antonio, Porto, Portugal; 11Hospital Torrecárdenas, Almeria, Spain; 12Universitätsklinik Für Augenheilkunde Und Optometrie, Der Paracelsus, Austria; 13AOU Careggi, Clinica Oculistica, Università Degli Studi di Firenze, Firenze, Italy; 14Hôpital Gabriel Montpied, CHU de Clermont-Ferrand, Clermont-Ferrand, France; 15Hôpital Bicêtre, Université Paris Sud, Paris, France Objective: The objective of this study was to compare systemic exposure to tropicamide/phenylephrine following intracameral or topical administration before cataract surgery. Patients and methods: Mydriatics exposure was calculated in patients randomized to intracameral fixed combination of mydriatics and anesthetic ([ICMA]: tropicamide 0.02%, phenylephrine 0.31%, and lidocaine 1%, N=271) or mydriatic eye drops ([EDs]: tropicamide 0.5% and phenylephrine 10%, N=283). Additional doses were permitted if required. Mydriatic plasma levels were determined by mass spectrometric HPLC in 15 patients per group before and after administration.Results: Most ICMA patients (73.6%) received a single dose (200 µL) representing an exposure to tropicamide of 0.04 mg and phenylephrine of 0.62 mg. None of these patients received additional mydriatics. In the control group (three administrations), the exposure was 0.45 (11.3-fold higher than ICMA) and 10.2 (16.5-fold higher) mg. When additional ED was used in this group (9.2% of patients), it was 37.5-fold higher for tropicamide (10 drops, 1.5 mg) and 54.8-fold higher for phenylephrine (10 drops, 34 mg) than the recommended ICMA dose. Tropicamide plasma levels were not detectable at any time point in ICMA patients while it was detectable in all ED patients at 12 and 30 minutes. Phenylephrine was detectable in 14.3% of ICMA patients compared to all ED patients at least at one time point. More ED patients experienced a meaningful increase in blood pressure and/or heart rate (11.2% vs 6.0% of ICMA patients; P=0.03).Conclusion: Systemic exposure to tropicamide/phenylephrine was lower and cardiovascular (CV) effects were less frequent with ICMA. This could be of particular significance in patients at CV risk. Keywords: cataract surgery, intracameral mydriasis, topical mydriasis, systemic influence, cardiovascular safety
format	article
author	Guell J Behndig A Pleyer U Jaulerry S Rozot P Pisella PJ Robert PY Lanzl I Pourjavan S Aguiar C Fernandez J Grabner G Mencucci R Chiambaretta F Labetoulle M
author_facet	Guell J Behndig A Pleyer U Jaulerry S Rozot P Pisella PJ Robert PY Lanzl I Pourjavan S Aguiar C Fernandez J Grabner G Mencucci R Chiambaretta F Labetoulle M
author_sort	Guell J
title	Systemic exposure to intracameral vs topical mydriatic agents: in cataract surgery
title_short	Systemic exposure to intracameral vs topical mydriatic agents: in cataract surgery
title_full	Systemic exposure to intracameral vs topical mydriatic agents: in cataract surgery
title_fullStr	Systemic exposure to intracameral vs topical mydriatic agents: in cataract surgery
title_full_unstemmed	Systemic exposure to intracameral vs topical mydriatic agents: in cataract surgery
title_sort	systemic exposure to intracameral vs topical mydriatic agents: in cataract surgery
publisher	Dove Medical Press
publishDate	2019
url	https://doaj.org/article/0ad0ca44d77b4bd39647b4d62d923e1a
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Systemic exposure to intracameral vs topical mydriatic agents: in cataract surgery

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