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 INSTITUTE CHANDIGARH, 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 P ilocarpine.-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 % A s 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 O cular 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 S ystemic 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 ( mmHg) and Group 2 ( mmHg). Uncorrected visual acuity was significantly better (p< 0.01) in Group 1 ( ) as compared to Group 2 ( ). At 6 hours after surgery, IOP was significantly higher (p< 0.01) in Group 2 ( ) as compared to Group 1 ( ) 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 Decimal Scale

v Group2 hours6 hours24 hours Pilocarpine No Pilocarpine 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